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Diabetes Epidemic Facing in US and the Resulting Impact on Health Care and Costs

Diabetes is characterized by increased blood glucose level due to defect in insulin action , insulin production or may be both. If preventive measures are not taken it may lead to severe complications and premature death.1 Diabetes is the sixth leading cause of death in United States and fifth leading cause in New York . In America , an estimated 21 million suffer from diabetes and 41 million are prediabetic . Poor glycemic control , hypertension, obesity, cigarette smoking and elevated level of cholesterol can lead to increased severity of complications . Diabetes is a chronic disease which is associated with various complications that leads to increased cost burden both at individual and national levels. About 70% of the cost associated with diabetes has been attributed to complications such as cardiovascular diseases . About 75% of the patients suffering from diabetes tend to suffer from heart disorders at some point of their life. Increased risk of complications has led to aggressive treatment which has also contributed to the increasing healthcare costs.2, 3, 4 Economic burden is the major concern for many developing and developed countries. Total cost of diagnosed diabetes patients in United States was $174 billion in 2007 which included $116 billion as direct costs and $58 billion as indirect costs such as disability, work loss, and premature mortality. In U.S., the healthcare cost of each patient related to diabetes is around $ 11,157 per year . Total cost of diabetes with undiagnosised, prediabetes and gestational diabetes in U.S. is about $218 billion . Individuals with diabetes spent twice that of healthy individuals for healthcare related needs. Awareness of current and future economic impact is very much needed among government and non government organizations, diabetes associations, health professionals and patients suffering from diabetes. 1, 5 Lack of early identification of the disorder and its poor management are some of the major factors that result in increased risk of developing complications and the related hike in healthcare costs . Poverty is the universal cause of poor management wherein individuals prefer to pay up for their food rather than pay for medical expenses. Lack of awareness about the disease and its related complications is also among the prime reasons for rising incidence rates. Standing apart from all these factors is the rapid increase in the number of obese people in the U.S. More and more people and alarmingly children are becoming obese at a very early age increasing the risk of developing diabetes manifold at younger ages. This has resulted in higher insurance costs, lack of productivity and low overall quality of life. 3, 6 The increasing economic burden can be reduced by improved participation by the government, healthcare providers, non-government organizations, diabetics and the people in general. While the government is forming policies to ensure better care and early recognition of the disease, the healthcare providers and the non-government agencies should consider partnering with the government in reducing the healthcare costs. Diabetics and other healthy individuals should take steps to increase their awareness about the disorder and its related complications. Significant improvement in treatment adherence, persistence and lower annual cost in individuals with diabetes leads to control of diabetes and decreased complications. Lifestyle intervention reduces the risk of diabetes by 58% and the reduction rate was even greater in adults aged 60 years or older (71% ). Lifestyle interventions have also been shown to be more cost-effective than medications. Quality improvement programs and disease related management programs have led to significant public investment to prevent the disease. 7-9 Such changes can significantly reduce the economic burden both on developed and developing countries.

Reference: 1. National Center for Chronic Disease Prevention and Health Promotion. 2007 National Diabetes Fact Sheet. [updated 2008 Jun; cited 2009 Nov]. Available from: http://www.cdc.gov/diabetes/pubs/general07.htm#gen_. 2. Steinbrook R. Facing the Diabetes Epidemic-Mandatory Reporting of Glycosylated Hemoglobin Values in New York City.NEJM. 2009, 354(6):545-548. 3. World Socialist Web Site. Diabetes in the US: a social epidemic. [updated 2006 Jan; cited 2009 Nov]. Available from: http://www.wsws.org/articles/2006/jan2006/diab-j30.shtml. 4. Mary Woodard Lasker Charitable Trust. Facts about diabetes. [cited 2009 Nov]. Available from: http://www.laskerfoundation.org/advocacy/pdf/factsheet3diabetes.pdf 5. American Diabetes Association. Diabetes Statistics [cited 2009 Nov]. Available from: http://www.diabetes.org/diabetes-basics/diabetes-statistics 6. American Diabetes Association. Economic costs of diabetes in the U.S. In 2007. Diabetes Care. 2008 Mar; 31(3):596-615. http://care.diabetesjournals.org/content/31/3/596.full.pdf+html. 7. Balkrishnan R, Rajagopalan R, Shenolikar RA, Camacho FT, Whitmire JT, Anderson RT. Healthcare costs and prescription adherence with introduction of thiazolidinedione therapy in Medicaid type 2 diabetic patients: a retrospective data analysis. Current Medical Research and Opinion. 2004, 20, (10), 1633-1640. 8. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics, 2007 fact sheet. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 2008. http://diabetes.niddk.nih.gov/DM/PUBS/statistics. 9. Huang ES, Zhang Q, Brown SES, Drum ML, Meltzer DO, Chin MH. The Cost-Effectiveness of Improving Diabetes Care in U.S. Federally Qualified Community Health Centers. Health Serv Res. 2007; 42(6 Pt 1): 2174–2323.

19.12.2009. 19:37

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