About a million people in the Netherlands have adult-onset (type 2) diabetes (T2D). Most of them would not need any medication if they changed their lifestyle. This would lead to savings of something like 2.7 billion euros over a five-year period. TNO and Leiden University Medical Centre (LUMC) signed an agreement at the end of January concerning cooperation aimed at developing the concept of ‘Lifestyle as a Medicine’.
The team that set up the ‘Lifestyle as a Medicine’ project included internist and endocrinologist Hanno Pijl from LUMC, together with Ben van Ommen and Hanneke Molema from TNO. Hanno has been treating people with type 2 diabetes for years. “This disease is caused by a combination of lifestyle factors and genetic predisposition. In fact, we let people do all the wrong things and then try to solve the problems that arise with the aid of pills and injections. That’s a very strange course of action: we need to take a different approach,” he concluded.
Biologically reversible disease
“I first came into contact with Hanno seven years ago,” said Principal Scientist Ben van Ommen. “We have been investigating the mechanisms of metabolic diseases at TNO for years. One study on diabetic mice showed that none of the pills tested was totally effective. Following a change of diet, however, they were completely cured. A year ago Hanno Pijl got eleven T2D patients to follow an intensive lifestyle programme. The results were spectacular: the patients were able to reduce the amount of medication they were taking by an enormous factor in the space of a few weeks. “This is the power of lifestyle change,” enthused Bert van Ommen. “It proves that type 2 diabetes is a biologically reversible disease.”
"Our entire healthcare system is based on the idea of paying for disease and the pills the patients take – in fact, on maintaining the state of ill health. How can we turn things around?"
Investing in lifestyle
Health scientist Hanneke Molema developed the ‘Lifestyle as a Medicine’ business case in cooperation with consultancy bureau Vintura. “Our entire healthcare system is based on the idea of paying for disease and its increasing complications, the pills that patients take – in fact, all our efforts seem to be directed towards maintaining the state of ill health. How can we turn things around, and make investment in the health of patients and the general population attractive? The government, insurers, companies and the other parties involved all understand that investment comes before the returns; but it takes a long time for the investments to pay for themselves, and the benefits are often felt by other parties than the investors, such as employers. As far as the patients are concerned, however, the main benefit is the improvement in health.”
There were 990,000 registered T2D patients in the Netherlands in 2016, and roughly 55,000 new patients are added to the total every year. The average age of onset of diabetes is 55. The total treatment costs for each patient, to the end of his or her life, amount to about 130,000 euros. If 40% of all T2D patients could be permanently cured, this would save Dutch society about 2.7 billion euros in medical expenses over the next five years.
Diabetes has an enormous effect on people’s lives. Patients have to take pills or inject themselves with insulin on a daily basis. In the long term, diabetes can cause nerve damage, cardiovascular disease and blindness. ‘Lifestyle as a Medicine’ offers people a better quality of life. “They are more active and less tired,” said Hanneke Molema, “and they may be able to go back to work if they had had to give it up. They can make a greater contribution to society, and their productivity increases. In addition, they suffer much less from other lifestyle-related complaints such as cardiovascular diseases. But changing your lifestyle is not an easy matter; it makes great demands on the individuals concerned, on the health service and on society.”
"Thanks to ‘Lifestyle as a Medicine’, people with type 2 diabetes are more active and less tired. And they may be able to go back to work if they had had to give it up"
GPs will have an important role to play in supporting the ‘Lifestyle as a Medicine’ concept. “But they don’t yet have the tools they need to do this job,” said Hanno Pijl. “TNO and LUMC are working together to develop a ‘Lifestyle as a Medicine’ toolbox that can be used by GPs, nurse practitioners and other nurses, dietitians and coaches to provide patients with the guidance they need. In addition, we will be arranging much improved training courses for GPs and specialists on the possibilities offered by nutrition and lifestyle changes. We hope to start these courses in mid-2018.”
New service economy
Vintura’s calculations indicate that continuing the treatment of diabetic patients costs thirteen times as much as an intensive lifelong lifestyle programme aimed at their cure. It is true that they need help to maintain a healthy lifestyle. But the support required to sustain this lifestyle throughout one’s life is much more than the current healthcare system can offer. Apart from a healthy diet, factors such as more exercise, enough sleep and the avoidance of stress are all important components of a proper lifestyle. “How do you support someone in his or her new lifestyle?” asked Bert van Ommen. “How do you make sure that any progress achieved is sustained in the long term? By using coaches? Or an e-health approach? In fact, society as a whole needs to change its attitude to this issue, by introducing an appropriate service economy aimed at making and keeping us healthy.”
All three members of the ‘Lifestyle as a medicine’ team are aware that much needs to be done to achieve this innovation in healthcare. Apart from setting up and coordinating new (applied) research and education as the primary objective of the joint TNO – LUMC project, work has to be done to build up an effective regional, national and even international ‘Lifestyle as a Medicine’ network. “We are currently looking for partners who are willing to share the investment in our innovative approach” said Hanneke Molema. And Hanno Pijl added, “It’s really time that we start to realize that a healthy society is actually the most successful form of society.”