What is ‘cardiodiabesity’?

By Jordan Taggart, SVP Payer and PBM Growth at Vida Health

A cluster of expensive chronic conditions is climbing at an alarming rate. Experts predict that in just six more years nearly half of all Americans will have obesity, over 40% will have some form of cardiovascular disease, and more than 12% will have diabetes. Even worse, having one of these conditions immediately multiplies the risk of getting diagnosed with another.

Some in healthcare are starting to refer to this triple threat as “cardiodiabesity.” It’s a mouthful — hard to say if patients could easily parse the term. But it does represent an acceptance that chronic conditions cannot be managed in siloes. Healthcare organizations and employers are increasingly recognizing that obesity and its comorbidities are interconnected, and are voting with their dollars by investing in solutions that treat them together.

Managing “cardiodiabesity” to improve outcomes and reduce costs requires addressing a combination of behavior change, medication, and socioeconomic barriers. New anti-obesity medications like GLP-1s can’t be ignored, as they show a lot of promise not just for weight loss and diabetes, but heart disease too — even reducing cardiovascular events by up to 20%. However, anyone who says medications are the only way – or never the way – is ignoring the nuances of human nature and diversity.

We need to take a more holistic approach to care for the millions of people grappling with various — and increasingly severe — forms of “cardiodiabesity” right now.

Prevention doesn’t help those already sick

There’s no question we need to invest more in preventive solutions. The more we can stop obesity and prediabetes in its tracks, the better off we’ll be in the next 10 to 15 years and beyond. However, over 27% of Americans have two or more chronic conditions today. These people need expert-level comprehensive care from teams with deep experience treating the whole person, not just one aspect of their conditions like “just obesity” or “just cardiovascular disease”. Much of traditional healthcare system is not set up to provide this care without a step-change in care models, and those that are lack the technology and consumer-oriented tools to drive sustained engagement. 

Episodic appointments with endocrinologists and cardiologists every few months just don’t cut it for people dealing with very complex conditions that require constant vigilance and a high level of health literacy. And primary care providers often do not have the tools, incentives, or time.  Their patients need more holistic continuous care between visits to cut down on hospitalizations, increase medication adherence, and develop habits to improve their health.

Continuous care for high-acuity populations drives down costs

I’m encouraged to see more forward-thinking health plans and PBMs partnering with cardiometabolic solutions to provide continuous care to those patients with high acuity conditions.

These patients carry a heavy burden. Their conditions require watchful attentiveness to various biomarkers like blood pressure and blood sugar levels, which can take a mental and emotional toll day in and day out. In fact, people with diabetes are two to three times more likely to have depression — which can then affect their motivation to stay on top of their high-maintenance conditions.

But cardiometabolic solutions provide care teams of registered dietitians, diabetes educators, health coaches, and prescribing physicians to help people control their blood pressure, blood sugar, and cholesterol levels every day — and provide the emotional support they need to feel more in control of their health. Those care teams can offer culturally adapted nutrition guidance and customization for various social determinants of health patients face. It’s that kind of continuous care that really improves patient outcomes and saves health plans and their partners substantial costs.

GLP-1s aren’t the silver bullet

While new GLP-1s carry a lot of promise in treating these linked conditions, they’re not a silver bullet. Up to 50% of people taking GLP-1s experience significant side effects including nausea, vomiting, and diarrhea. Those side effects can be especially debilitating for people with high acuity conditions and cause even more complications — and affect adherence rates.  Only a quarter of people continue taking a GLP-1 after one year. At a price point of up to $16,000 per person per year, we can’t afford to prescribe GLP-1s to everyone who wants them as a quick way out of this chronic disease epidemic. We need to judiciously identify the right candidates for the drugs — and then fully support them for the most sustainable outcomes.

I’m reminded of an episode of The Daily, a popular New York Times podcast, from a few months back that illustrated the need for expert, continuous care. The Daily told the story of two women’s experiences with GLP-1s, one positive and one negative. In the latter vignette, the woman’s nausea became so unbearable that she stopped taking the drug, but not before experiencing malnutrition because eating healthily became so difficult. A dietitian could’ve helped this woman deal with her side effects and ensure proper nutrition — vastly improving her outcomes. If more patients had access to this kind of support, perhaps we’d see more people with positive experiences and more plan sponsors with successful outcomes and cost mitigation.

Holistic answers to a triple threat

The truth is no single medication can solve for the many different factors that contribute to cardiovascular disease, diabetes, and obesity. We have to support people from all angles, helping address social determinants of health, giving mental health support, offering dietary guidance, and prescribing appropriate anti-obesity medications when necessary. Those who do receive GLP-1s need to get continuous support from expert care teams to ensure optimal results.

Cardiodiabesity has no easy answer. But recognizing the interrelated nature of these clustered conditions — and investing in human-centered solutions to mitigate them  — is a big step forward.