As most clinicians know, diabetes is a serious disease that requires life long management and is one of the biggest challenges to U.S. healthcare. But an even more pressing problem is the dramatic increase in diabetes while awareness of the disease and how to prevent it remains low. Causes of diabetes, particularly type 2--sometimes referred to as adult-onset diabetes--are primarily due to the lack of a healthy diet (adding to the nation's obesity epidemic) and a sedentary lifestyle. While the causes and effects of this disease are well known among the medical industry and insurance companies, evidence indicates a profound lack of diabetes awareness among the general population.

This phenomenon is not unique to the U.S. Just as our diets and lifestyles have changed dramatically over the past few decades, such as dining out more often, increasing our intake of corn sugar, and replacing physically demanding jobs with desk jobs, we're also exporting these bad habits across the globe. Countries such as China are experiencing an explosion of obesity in their population, something that was almost unheard of in the past, as they've taken a liking to western foods and habits. The obesity epidemic in China is a precursor to a diabetes crisis of their own. It's estimated that the number of people living with diabetes worldwide will rise from 366 million in 2011 to 552 million by 2030. The impact on society in health care costs (including health insurance and medical treatments) and lost productivity will be enormous, and no amount of health care reform will be able to manage the resulting deluge.

But what can be done to raise awareness and stop the rise of this disease and reduce the resulting health care costs? Isn't it a matter of personal responsibility to develop healthy lifestyles for true health? Many ideas are being considered in health care reform and by insurance companies to pursue this course of action. For example, health care reform may initiate a Fat Tax on overweight individuals. People suffering from diabetes have on average higher medical treatment costs. Would this be a good example of personal responsibility? It would increase awareness, but there may be a backlash. And what role should insurance companies play in this debate? As it now stands, insurance companies are still going to play a big role in health care reform. One of the biggest changes for these companies is the requirement that no more than 20 percent of revenues can be used for anything other than direct medical costs. This provides a big incentive to reduce health care costs by promoting healthy lifestyles. Another consideration by insurance companies is increasing health insurance rates for overweight individuals through charging higher co-pays or annual premiums, or to cap medical treatment (ration health care). And what if insurance companies simply dropped high risk individuals? Many who practice personal responsibility for their health care argue that they pay too much in health care costs because they are force to share the costs of the unhealthy through higher health insurance rates.

So how can we promote healthy lifestyles and personal responsibility in a way that will improve overall health care and reduce health insurance rates such as improving a healthy diet to reduce the obesity epidemic? This is the perhaps the biggest issue facing the U.S. healthcare system today. By developing a healthcare systems that promotes personal responsibility to prevent disease rather than one that focuses on medical treatment, we all win with the resulting healthier population and significant health care cost savings. It will require a paradigm change for all citizens and the medical community, but if we're to live in a country that can provide affordable health care and health insurance, and afford health care reform that will underwrite health care costs for the poor and elderly, we're going to have to move in this direction.