Medical experts call diabetes a growing epidemic. About one in three people will get the disease, approximately 24 million people already have it.
Many people can prevent diabetes with simple lifestyle changes, but Medicare and most private insurance programs don't pay for prevention efforts.
That gap could be plugged by legislation included in the health care reform bill working it's way through the U.S. Senate.
A year ago, Suzanne Rosenberger got her lunches at fast food restaurants. Today, her lunch is in a tote bag she brought from home.
"My lunch is actually in my closet," she said. "Two bananas and three tangerines. That's my lunch."
Rosenberger's transition from burgers and fries to fruit began last spring. Blood tests showed she had an elevated level of glucose, a form of sugar the body uses for energy.
People with diabetes don't break glucose down properly, and the disease can lead to other health problems like a heart attack or stroke.
A person's risk of developing diabetes is much higher after age 45. Rosenberger, an office manager at an auto body repair shop, is 48.
The doctor told her she was pre-diabetic, meaning she would get the disease if she didn't lose weight.
"I really was scared when I heard the word diabetic," she said. "Back when I was very little I remember my aunt that was such a wonderful woman and had both legs amputated...and that scared me to death."
Rosenberger, who is uninsured, struggled to change her lifestyle on her own until a state program referred her to a class at the East St. Paul YMCA.
Rosenberger was one of five people who took the 16-week course.
They learned to do 30 minutes of exercise a day, like a brisk walk after lunch. They counted up calories and figured out where they had to cut down. They talked about how to eat well while eating out or at parties, and they discussed getting back on the wagon if they fall off.
Rosenberger lost 18 pounds.
"The structure of the class really made you aware of how much you're putting in your mouth, what you're putting in your mouth, and to be active," she said. "I was able to start feeling better... I wasn't as dizzy or disorientated. [I] was jumping back into clothing I had stuffed into the closet. Loved that."
Rosenberger's YMCA class was part of a pilot program based on a National Institutes of Health study. The study showed some weight loss and exercise cut participants' risk of developing diabetes in half.
The pilot program was tested in a handful of states. It showed the NIH study's results could be duplicated on the community level at little cost.
That sounds simple, but it hadn't been done before.
"Everybody talks about prevention being important but there really hasn't been many dollars allocated to prevention," said Dr. Richard Bergenstal, executive director of the International Diabetes Center in St Louis Park, Minn. "Because it's a long term problem and everyone wants to fix something in the short term."
Bergenstal, who is also president-elect of the American Diabetes Association, said to change health care in a significant way, policy-makers need hard data.
"We have all the evidence we need now to say it can be accomplished, it can be sustained, and now we can show that we can do it on a community level in a cost effective way," he said. "So the time is right to finally implement a prevention strategy for diabetes."
New legislation would fund the pilot program in more states. It would be a step toward taking the programs everywhere.
Sen. Al Franken, D-Minn., is one of two sponsors for the Diabetes Prevention Act.
"To me, this is just a no-brainer," Franken said. "If we can intervene before these Americans develop full blown diabetes we'll save billions of dollars and not incidentally avoid the burden of diabetes for millions in our country. It's really a win-win."
A University of Chicago study published this month predicts spending on diabetes will jump from $45 billion now to $171 billion in the next 25 years.
Bergenstal said the community-based prevention programs will cost about $300 per person annually.
"I really this think this could be a big step for our country -- for preventing one of the most costly diseases that's out there today - diabetes."
And it could happen soon. Franken has tacked the Diabetes Prevention Act on as an amendment to the Senate's health care reform bill, in an effort to get it passed quickly.