Dispatch From 2025: How We're Putting a Big Dent in the Spread of Diabetes (Part 4)

Editor's Note: How might the nation achieve the urgent moonshot laid out in Part Three of this series? The following “future history” report from the year 2025 lays out a possible path towards success.

CHICAGO—June 25, 2025—Sally Yelacic beamed as she walked out of the converted warehouse that houses the Y on West Van Buren Street on Chicago’s Near West Side. Speaking up, to be heard over the noise from the Eisenhower Expressway nearby, the 46-year-old seamstress said she had just been told that a healthy-lifestyle program she had attended through the Y had lowered by almost two-thirds her odds of developing diabetes.

“I used to think diabetes was inevitable,” she said. “But now I know what to do to prevent getting the disease, and I’m doing it. And I’m getting my family and friends to do it. My parents were diabetic. My cousins were diabetic. I was just waiting for my turn. But now I know I can do something. Every day I’m giving up a Coke. I’m walking more.”

While Yelacic had thought she could head off diabetes only through heroic effort—“or a miracle,” she said—she learned that merely dropping 15 pounds, or about 7% of her body weight, would tilt the odds greatly in her favor. She vowed to keep going, too, and live a much healthier lifestyle, now that she had restored her hope.

The program at the Y and many like it have reduced the risk of diabetes and related conditions like high blood pressure for more than half a million people. In a quiet revolution led by the American Medical Association, doctors across the country have been steering patients into lifestyle-change programs at the Y and hundreds of other providers that the federal government, led by the Centers for Disease Control and Prevention, have nurtured for over a decade as part of its National Diabetes Prevention Program (National DPP).

Yelacic shows how the system is working.

Like many busy doctors, Yelacic’s primary care physician, Margaret Beck, spent little time thinking about the AMA and wasn’t a member, but she paid attention when the AMA made diabetes prevention one of its highest priorities.

“I was doing what I was supposed to do,” Dr. Beck said. “I counseled patients about their weight, blood pressure and so on. But the efforts of the AMA, the CDC, the Y and other pioneers gave me an easy way to do more.”

During a regular physical, Dr. Beck identified Yelacic as having prediabetes, putting her at high risk for type 2 diabetes (the most common type), heart disease, and stroke. Dr. Beck walked Yelacic through a simple checklist that helped her choose among treatment options that could reduce her risk of developing full-blown diabetes.

Coaching programs (which research showed to be usually more effective than medications) came in a wide variety of formats. Some involved face-to-face meetings with health and diet coaches. Some worked virtually over video or chat. Others were a mix of in-person and virtual. Some even offered customized, always-available AI coaches, rather than human ones.

The common thread was that all were based on solid science, recognized as effective diabetes prevention programs (DPPs) by the CDC and covered by insurance. And, they were all offered during the simple process that Dr. Beck stepped through with Yelacic to choose the right program for her, enroll her and get her started.

“I’ve learned,” said Dr. Beck, “that just telling patients to consider a chronic disease prevention program isn’t enough. That was better than the old days, when we’d just tell patients, ‘Lose weight and see me in a year’—but not much better. Now, I take three minutes to walk patients through the options and refer them to the right program, and it makes all the difference. And, not that I needed one, there’s even a billing code for prevention counseling.”

Yelacic agreed to go to the Y, enrolled while still in Dr. Beck’s office, and scheduled her first appointment.

At the Y, Yelacic had a series of in-person and video counseling sessions over the first several months, mostly on easy ways to adjust her diet and get more exercise. She got an Internet-connected scale that logged her weight each day. She joined an online support group with others in the program (which soon included several friends and coworkers) that is moderated by a coach. And, she had a personal coach who gave her that extra nudge when she needed it.

The Y sent Dr. Beck updates on her patients’ attendance and weight loss, and Dr. Beck’s office sent occasional encouraging emails to them, over Dr. Beck’s name. Yelacic began losing weight as soon as she entered the program, and the weight has stayed off. Her blood pressure has also dropped.

Research suggests that Yelacic’s experience is becoming typical. Because of the position of respect that doctors occupy, 70% of patients they refer to the DPPs go to at least one session, according to several well-regarded research studies. Those who attend at least one session eventually lose 5% to 6.8% of their body weight. They gain some back, but their weight is, on average, still down 4.8% 28 months after they enter the prevention program.

“It is progress that has been too long in coming,” said Erin Yates, a researcher with JKL Corp. “Research conclusively showed the effectiveness of well-designed lifestyle change programs to prevent the slide from prediabetes to diabetes almost 20 years ago. But it took almost an entire generation before doctors and the rest of the healthcare industry shook the misconceptions that prevention couldn’t work, was too expensive or took too long.”

A turning point occurred in 2018, when the results of a large-scale study at the Y led Medicare to start covering diabetes prevention services for seniors. The Y's program, developed with an $11.8 million innovation grant from the CDC, worked with 42,000 participants across 45 states.

‘One of every three Medicare dollars was being spent on patients with diabetes at that point,” said Yates. “By reducing the risk of diabetes for many participants, the Y saved Medicare about $2,650 per participant over 15 months. That's much more than the cost of the preventive program.”

As a result, diabetes prevention became the first chronic disease prevention program to qualify for Medicare coverage under Obamacare.

“The savings are really just icing on the cake,” said Yates. “Prediabetes affects tens of millions of seniors, and studies show the majority of them will eventually develop diabetes. Just consider all the pain and suffering those people will avoid!”

Kai Wan, an industry analyst at KWJM Research, said: “Getting Medicare coverage for the program was a critical step because it encouraged employers and commercial insurance plans to consider covering prevention services. It also signaled to entrepreneurs and investors that there was a viable business opportunity in chronic disease prevention. Almost 85 million adults had prediabetes back then. That’s a tragic number—and a huge market.”

He said the progress on prediabetes could trigger interest in business opportunities in other prevention programs, noting that 90% of the country’s $3.3 trillion in annual healthcare spending is for people with chronic and mental health conditions. The CDC estimates that eliminating three risk factors—poor diet, inactivity, and smoking—would prevent 80% of heart disease and stroke, 80% of type 2 diabetes and 40% of cancer.

“Can we eliminate them all? Of course not,” Wan said. “But, learning how to scale the kind of behavior change that DPPs have proven possible for diabetes prevention holds enormous promise for other conditions, as well..”

Still, the early entrants faced stiff headwinds. Even after Medicare accepted the effectiveness of prevention programs, there wasn’t much demand for them because an estimated 90% of those with prediabetes didn’t know it, and most doctors didn’t screen for it, Wan said. Those few doctors who did screen for prediabetes, like Dr. Beck, tended to not refer patients to prevention programs because insurance coverage was spotty and there were few programs.

This created a chicken-and-egg problem because, without sufficient demand, the availability of programs remained limited.

For example, in Mississippi—which ranked 49th in the country for diabetes and obesity—almost no commercial insurers reimbursed for diabetes prevention and, even though Medicare covered the treatment, there were almost no approved suppliers in the state, according to Phil Trotter, who was working hard to promote diabetes prevention in that state.

“Medicare made a crucial blunder in how it approved coverage for diabetes prevention,” said Zoe Jenkins, an industry analyst at ZEJ Research. “Everybody knew virtual programs were as effective as in-person, onsite programs like the early Y programs, and patients preferred virtual programs because of availability and convenience. But, due to cost concerns, Medicare chose to cover only in-person programs. That really limited access and slowed adoption.”

Still, pioneers plugged away.

Omada Health, the largest virtual DPP, worked directly with forward-thinking commercial insurers and employers. Big, self-insured employers, like Costco and 3M, recognized the win-win for themselves and their employees in offering diabetes prevention programs. That inspired more insurers to offer coverage options and more employers to sign up.

Solera Network, another early startup, tackled the administrative headaches of verifying insurance coverage, connecting patients with in-network prevention programs, billing, etc. "Solera added an intermediate layer of cost that was challenging for many DPPs, especially the smaller programs," Jenkins said. “But by lowering the administrative burden, Solera made it possible for a lot of insurers to offer this benefit.”

Once the CDC, the Y, Omada, Solera and others provided critical pieces of the ecosystem, doctors pushed prevention into high gear.

The AMA’s early work with the Y highlighted the critical role of doctors. “The teachable moment comes when patients learn they have prediabetes from their physicians,” said Karen Kmetik, who runs the AMA initiative on improving health outcomes. “If the doctor and her care team take advantage of that moment of urgency and guide the patient to a diabetes prevention program, the patient is much, much more likely to enroll and follow through. If not, the patient is likely to do nothing.”

Kmetik and her team of physicians, nurses, public health experts, economists and clinical improvement specialists crisscrossed the country helping to lay the foundation for a sustainable system focused on prevention. They pushed for Medicare, Medicaid and commercial insurance coverage. They helped stand up diabetes prevention programs. They raised physician and patient awareness and encouraged enrollment. Critically, the AMA also pushed for coverage of virtual programs and quality metrics on how well physician practices and health care organizations did. They also took a long-term view and sponsored foundational work to integrate diabetes prevention into emerging standards of care for prevention of other chronic diseases, like cardiovascular disease.

“We are neutral like Switzerland,” said Shannon Haffey, director of prevention-related strategies and partnerships at the AMA. “Commercial stakeholders were competing for position in the small market for diabetes prevention. This made sense for them, perhaps. We wanted to help everyone. Our mission is to increase the size of the whole market because that leads to the best access, treatment and outcomes for patients.”

Kmetik said, “It’s like a big flywheel. We knew that if we could give the system a couple of big pushes and gain momentum, a virtuous cycle of more patients, more prevention programs and better outcomes would kick the whole system into gear.”

North Carolina shows the virtuous cycle in action. In 2019, about 2.6 million people lived with prediabetes, and an estimated 53,000 were diagnosed with new cases of diabetes each year. BlueCross BlueShield of North Carolina, the state’s largest commercial insurer, invested $5 million in Diabetes Free NC, a public/private partnership. The AMA, along with the North Carolina Medical Society, joined the initiative. They mounted a campaign to make every primary care physician and care team member in the state aware that they should refer their patients with prediabetes to a prevention program.

The first year was hard. Startup costs were high. The partnership grappled with the lack of infrastructure and awareness, barely reaching its minimal goal of enrolling 5,000 North Carolinians into DPPs. Yet two years later, powered by greater awareness, a much-streamlined app and economies of scale, enrollment jumped to 50,000. It reached 200,000 this year.

“Between 2019 and 2021, we focused on early markets like North Carolina, where the gears of the flywheel were in place and our help could a make a big difference,” said Kmetik.

While the AMA focused on rallying care givers, it also leveraged the credibility of its brand to drive patient awareness. It worked, for example, with the Ad Council on public awareness campaigns that have reached more than 100 million people, millions of whom went on to take a personal diabetes risk test.

Sally Yelacic was one of those who saw the commercials and billboards. She went online to take a diabetes risk test, confirming her fears and making her more open at that fateful appointment with Dr. Beck.

A second inflection point happened in late 2021. By then, more than 20 million people with prediabetes had been identified and offered treatment. Five million had undergone treatment in some form. Two million had enrolled in prevention programs.

The overwhelming evidence proved to employers that a focus on chronic disease management and prevention was not only popular with employees but also good for retention, productivity and other factors that contributed to the bottom line.

“The employee feedback was just overwhelmingly positive,” said Bob Ihrie, who was senior vice president of compensation and benefits at Lowe’s when it implemented a program with Omada Health.

The virtuous cycle kicked into gear nationally. Medicare and most Medicaid programs started covering virtual programs. Most commercial insurers expanded coverage. More corporate wellness plans incorporated evidence-based chronic disease prevention modules. Really big players, including Walgreens, Walmart and CVS, recently entered the market. Even Apple and Amazon, which have long toyed with getting into health and wellness services, look poised to jump in.

Between 50 and 60 million people with prediabetes now know it and have been offered some evidenced-based treatment, and about half of those are managing their risk.

“That’s still not good enough, because it means that there are still more than 50 million people at high risk for a horrible, preventable chronic disease,” said Kmetik, “but we are putting a sizable dent in new cases of diabetes. That’s a good start.”

Notes: This is a hypothetical history of the future. All quotes are fictional except where indicated. I have advised or am an advisor to several healthcare organizations, including the American Medical Association. No confidential information has been shared and all views are my own. For a very real plan to achieve the urgent moonshot, see Part 5: A Ten Point Plan.

-- Read the entire series:

• Why We Need A Moonshot For Diabetes Prevention (Part 1)
• 3 Misconceptions About Diabetes Prevention (Part 2)
• An Urgent Moonshot For Diabetes Prevention (Part 3)
• Dispatch From 2025: How We're Putting A Big Dent in the Spread of Diabetes (Part 4)
• Here's a 10 Point Plan for a Diabetes Prevention Moonshot (Part 5)

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I write, speak and advise on the digital future. I'm the author of four books on technology and innovation. This article is updated from one originally published at Forbes.