Diabetes is fast becoming a global epidemic, with over 380 million people living with the condition. In the United States, the number of people affected is about 30 million. Another 86 million Americans have pre-diabetes; a majority of them are not even aware they have it.
The economic impact of diabetes in the US is huge and is expected to increase in the coming years. The rising incidence of the disease is fueled by increasingly sedentary lifestyles, changing eating habits, and rapid urbanization.
The Economic Impact of Diabetes
Diabetes puts an enormous financial burden on patients, their families, and society. It reduces the chances of a person getting employed, or if a person has a job, decreases the actual amount earned due to absenteeism.
According to research released by The American Diabetes Association (ADA) on March 6, 2013, the total estimated cost of diagnosed diabetes in 2012 rose to $245 billion. It represents a 41% increase compared to five years ago.
Out of the total cost, $176 billion was attributed to direct medical expenses, while $69 billion was due to reduced productivity. The composition of medical expenditures is as follows:
- Hospital in-patient care (43%)
- Prescription medications (18%)
- Diabetes supplies and anti-diabetic agents (12%)
- Physician office visits (9%)
- Nursing or residential facility stays (8%)
The average medical expenditures of persons with diagnosed diabetes are $13,700 per year (total expenses), $7,900 of which is directly associated with diabetes. People with diabetes have 2.3 times more medical expenses when compared to people who do not have the illness.
Care for persons diagnosed with diabetes accounts for 20% of the total healthcare dollars in the US. Half of the amount spent can be directly attributed to diabetes.
Costs due to reduced productivity are as follows:
- Inability to work due to disease-related disability ($21.6 billion)
- Decreased productivity at work for people who are employed ($20.8 billion)
- Lost productive capacity because of early mortality ($18.5 billion)
- Absenteeism ($5 billion)
- Reduced productivity for people who are not in the labor force ($2.7 billion)
Diabetes Costs in the US
People with diabetes visit a doctor more often, experience longer hospital stays, and use more medical supplies and prescription drugs than people without the illness. Diabetes manifests itself through high blood glucose, high blood pressure, and high cholesterol levels.
A person with diabetes has a risk of developing complications such as heart attack, stroke, kidney problems, nerve damage, and blindness.
Direct health expenditures for diabetes include doctor/hospital visits, laboratory costs for tests, medications, and equipment costs. Indirect costs include lost income due to early retirement and work hours lost due to the illness.
- The total per-capita health expenditures of women ($8,331) are higher than men ($7,458).
- Of all the states in the US, California has the most number of people with diabetes, followed by Texas, New York, and Florida. The states with the highest costs are California ($27.6 billion) and Florida ($18.9 billion).
- Non-Hispanic blacks have the highest medical expenses ($9,540), followed by non-Hispanic whites ($8,101), and Hispanics ($5,930).
- Diabetes care in the US is shouldered by government insurance (62.4%), private insurance (34.4%), and by the uninsured (3.2%).
Causes Why Diabetes Is on the Rise in the US
There is a strong correlation between diabetes and being overweight. The incidence of obesity in the United States is on the rise; changing eating habits is the likely culprit.
In 1994, 55.9% of the adult population were either overweight or obese, with a body mass index (BMI) of 25 or higher. In 2008, this number increased; 68.3% of the adult population were either overweight or obese. BMI is body fat measurement which is based on the height and weight of a person.
Being overweight or obese reduces life expectancy. It also places a growing strain on health care in the United States. The rising number of overweight/obese persons is due to increased consumption of high-calorie foods (especially snack foods), sedentary lifestyle resulting in less physical activity, and changes in work environment.
A gain of 11 – 16 pounds doubles the risk of acquiring type 2 diabetes, while an increase of 17 – 24 pounds triples the risk. Obesity (especially abdominal obesity) is closely associated with insulin resistance, a characteristic of type 2 diabetes.
Diet counseling, exercise, and behavioral support can help obese adults lose weight. The results are improved glucose metabolism, blood pressure, and lipid levels.
Pre-diabetes is a condition wherein a person has a higher than normal blood glucose levels, but not high enough in order to be classified as diabetes. Without proper intervention, the condition can lead to full-blown diabetes.
The tests used to diagnose pre-diabetes are fasting plasma glucose test, oral glucose tolerance test, and hemoglobin A1C (average blood sugar level over the past two to three months). What is alarming is that only 7% of Americans are aware that they have the condition.
Although there is still no definitive cure for diabetes, there are ways to prevent or delay the progression of pre-diabetes into full-blown diabetes. Clinical trials show that modification in eating habits, moderate intensity exercise, and even modest weight loss can help a lot.
The non-production of insulin by the pancreas causes type 1 diabetes; it is treated with insulin injections. Type 2 diabetes may also be treated with insulin, but it is possible to control the illness with a combination of oral medications, diet, and exercise.
Diabetes medicines work in different ways, such as increasing insulin production and lowering the amount of glucose produced in the liver. Medications can also decrease the absorption of starches in the intestine and help the liver respond better to insulin, resulting in lower blood glucose levels.
Also, people with diabetes can benefit from supplemental medicines which aim to control blood pressure, cholesterol levels, and prevent cardiovascular problems and infections. Self-management is important in the treatment of diabetes.
Persons with diabetes are encouraged to receive education about diabetes from a physician and nutritional counseling from a licensed dietitian. They should also monitor their blood sugar levels regularly by using a handheld glucometer, lancets, and meter strips.
Additional health care visits may be necessary to review a patient’s self-care program and to adjust the medications accordingly. Diabetes patients are advised to undergo screening tests for the following: blood pressure, cholesterol levels, foot exams, eye tests, and kidney tests.
- Every percentage point drop in HbA1c test result lowers the risk of nerve, eye, and kidney complications by 40%.
- Every ten mmHg reduction in systolic blood pressure lessens diabetes complications by 12%.
- Improved cholesterol levels may reduce cardiovascular complications by 20% to 50%.
The economic impact of diabetes in the US is huge, and the health expenditures are increasing each year. This is due to the growing number of people with diabetes, which is estimated at almost 30 million Americans.
Add to that figure the 86 million individuals in the US with pre-diabetes, a majority of which are not aware that they have the condition. It is expected that numbers will continue to increase due to obesity, unhealthy eating habits, and sedentary lifestyle.
Education and counseling are very important in diabetes management. Regular consultations with a physician, blood sugar monitoring, healthy eating, and exercise can significantly reduce health risks and complications.