The Impact of Diabetes Mellitus in the United States

Epidemiology, Costs, and Future Pro ections

Table of Contents
Section
Epidemiology Costs Future Projections

Slide No.
3-28 29-37 38-43

Section

EPIDEMI!"!#$

Epidemiology of Diabetes
!i"#etes "$$ects 2%.8 million people o$ "ll "ges 8.3& o$ t'e (.S. popul"tion !i"gnosed) 8.8 million (ndi"gnosed) 7.* million +e"ding c"use o$ ,idney $"ilurenontr"um"tic lo.er-lim# "mput"tionne. c"ses o$ #lindness "mong "dults /"jor c"use o$ 'e"rt dise"se "nd stro,e Se0ent' le"ding c"use o$ de"t'
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Diagnosed and Undiagnosed Diabetes in %&'&

4 .9 million people 52* ye"rs o$ "ge ne.ly di"gnosed6 2 %-*** .ere 72* ye"rs 8$ t'e 2%.9 million : .3&; 52* ye"rs /en) 3.* million : .8&; <omen) 2.9 million : *.8&; Non-=isp"nic .'ites) %.7 million : *.2&; Non-=isp"nic #l"c,s) 4.9 million : 8.7&; >9% ye"rs- *.9 million :29.9&;
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

(acial)Ethnic Differences in Diagnosed Diabetes

2**7A2**9 n"tion"l sur0ey d"t" $or people "ges 2* ye"rs or older
?"ce3Et'nicity Non-=isp"nic .'ites 2si"n 2meric"ns =isp"nics3+"tinos Cu#"n 2meric"ns Centr"l "nd Sout' 2meric"ns /e@ic"n 2meric"ns Puerto ?ic"ns Non-=isp"nic #l"c,s & 7. 8.4 .8 7.9 7.9 3.3 3.8 2.9

N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Diagnosed and Undiagnosed Diabetes

Source: 2**%-2**8 N"tion"l =e"lt' "nd Nutrition E@"min"tion Sur0ey N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

*e+ Cases of Diagnosed Diabetes

Source: 2**%-2**8 N"tion"l =e"lt' "nd Nutrition E@"min"tion Sur0ey estim"tes projected to t'e ye"r 2* * N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

County,"e-el Estimates of Diagnosed Diabetes ./0, 1dults 2%& years, %&&3

Percent 0 6.5 * -A 9.% 6.6 8.0 9.9- A 8.* 8.1 9.4 8. - A 9.4 9.5 11.1 . 9.%- A > 511.2.2
....cdc.go0

*umber of 1mericans +ith Diagnosed Diabetes, '43&,%&&4

....cdc.go0

1nnual, 1ge,1d usted Incidence (ate of Diagnosed Diabetes5, %&&6,%&&7

MMWR. 2**86%7:43;)

99-

73.

Pre-alence of !-er+eight and !besity 1mong 1dults +ith Diabetes

C!C "n"lysis o$ pre0"lence o$ o0er.eig't "nd o#esity "mong (.S. "dults 52* ye"rs .it' pre0iously di"gnosed di"#etes 80er.eig't or o#esity) 8%.2& 8#esity) %4.8& <omen "ged 2*-94 ye"rs '"d " signi$ic"ntly 'ig'er pre0"lence o$ o#esity t'"n .omen 59% ye"rs o$ "ge :94.7& 0s 47.4&6 P7*.*%; during 999-2**2 2mong men- pre0"lence o$ o0er.eig't or o#esity ."s 89.3& "nd o#esity- %3.*&
MMWR. 2**46%3:4%;) *99- *98.

SE1(C8 for Diabetes in $outh Study !-er-ie+

Popul"tion-#"sed- o#ser0"tion"l study o$ p'ysici"n-di"gnosed di"#etes "mong yout' 72* ye"rs o$ "ge 1niti"ted in 2*** Funded #y C!C- N1= Collects d"t" $rom 9 centers 4 geogr"p'ic"lly #"sed :Color"do- 8'ioSout' C"rolin"- <"s'ington; 2 'e"lt' pl"n-#"sed :C"li$orni"- ="."ii;
C!CDCenters $or !ise"se Control "nd Pre0ention6 N1=DN"tion"l 1nstitutes o$ =e"lt' SE2?C= $or !i"#etes in Bout' Study Croup. Pediatrics. 2**96 8) % *- % 8.

SE1(C8 for Diabetes in $outh (esults

9379 yout' .it' di"#etes in " popul"tion o$ 43.% million 20er"ge "ge "t di"gnosis) 8.4 ye"rs 20er"ge dur"tion o$ di"#etes) %9 mont's :r"nge- 38-9* mont's; Estim"ted pre0"lence o$ (.S. yout' "ged *- 9 ye"rs .it' di"#etes in 2** .82 c"ses per *** yout' :9%& C1) .78- .87 per *** yout'; C"ncer) .24 per *** 2st'm") 2* per ***
SE2?C= $or !i"#etes in Bout' Study Croup. Pediatrics. 2**96 8) % *- % 8.

SE1(C8 for Diabetes in $outh Demographics, Pre-alence

C'"r"cteristic Eot"l popul"tion 2ge group *-4 y %-9 y *- 4 y %- 9 y Cender /"le Fem"le ?"ce3et'nicity N=< Fl"c, =isp"nic 2P1 21 No. o$ c"ses :&; 9379 2%% *94 2 2* 29 * :4.*; : 7.2; :33.2; :4%.9; Popul"tion denomin"torn :&; 3-499-849 829-%89 879-293 92%-429 898-%98 :23.7; :2%.*; :29.%; :24.8; Pre0"lence- c"ses per *** yout' :9%& C1; .82 : .78- .87; *.3 .2% 2.29 3.3% :*.27-*.3%; : . 8- .32; :2.2*-2.39; :3.23-3.47;

3 %9 :49.%; 3223 :%*.%; 4382 :98.7; 72 : .3; 829 : 3.*; 297 :4.2; 8* :2.8;

-787-2*8 :% . ; -7 2-938 :48.9; 2-*2%-429 :%7.9; 373-%99 : *.9; 94 -4 4 : 8.3; 32*-4*3 :9.2; 39-**4 :4.*;

.77 : .7 - .83; .88 : .82- .9%; 2. 9 .93 .29 *.83 .29 :2. *-2.23; : .79-2.*8; : .2 - .38; :*.74-*.94; : . 2- .%*;
8) % *- % 8. E"#le .

N=<Dnon-=isp"nic .'ite6 22D2$ric"n-2meric"n6 =D=isp"nic6 2P1D2si"n3P"ci$ic 1sl"nder6 21D2meric"n 1ndi"n SE2?C= $or !i"#etes in Bout' Study Croup. Pediatrics. 2**96

SE1(C8 for Diabetes in $outh &,4 $ears by (ace)Ethnicity

Pre-alence

N=<Dnon-=isp"nic .'ite6 22D2$ric"n-2meric"n6 =D=isp"nic6 2P1D2si"n3P"ci$ic 1sl"nder6 21D2meric"n 1ndi"n SE2?C= $or !i"#etes in Bout' Study Croup. Pediatrics. 2**96 8) % *- % 8.

SE1(C8 for Diabetes in $outh '&,'4 $ears by (ace)Ethnicity

Pre-alence

N=<Dnon-=isp"nic .'ite6 22D2$ric"n-2meric"n6 =D=isp"nic6 2P1D2si"n3P"ci$ic 1sl"nder6 21D2meric"n 1ndi"n SE2?C= $or !i"#etes in Bout' Study Croup. Pediatrics. 2**96 8) % *- % 8.

SE1(C8 for Diabetes in $outh Population Estimates, %&&'

Estim"ted num#er o$ c"ses o$ di"#etes mellitus- e@tr"pol"ted $rom SE2?C= d"t" %4-399 yout' :9%& C1) %*-489- %8-248; /"jority :78.7&; *- 9 ye"rs o$ "ge Non-=isp"nic .'ite) 92& o$ t'ose 72* ye"rs #ut 7 & o$ "ll c'ildren .it' di"#etes 32-89* c'ildren 7 * ye"rs o$ "ge Non-=isp"nic .'ite) 9*& o$ popul"tion #ut 77& o$ "ll c'ildren .it' di"#etes
SE2?C= $or !i"#etes in Bout' Study Croup. Pediatrics. 2**96 8) % *- % 8.

Prediabetes
1n 2**%-2**8- #"sed on $"sting glucose or 'emoglo#in 2 C le0els- predi"#etes ."s detected in 3%& o$ "dults "ges 2* ye"rs "nd older %*& o$ "dults "ges 9% ye"rs "nd older 2n estim"ted 79 million "dults "ges 3* ye"rs "nd older People .it' predi"#etes '"0e "n incre"sed ris, o$ de0eloping type 2 di"#etes- 'e"rt dise"se- "nd stro,e
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

#estational Diabetes
?"nge $rom 2&A *& o$ pregn"ncies Postp"rtum- %&A *& o$ .omen .it' gest"tion"l di"#etes "re $ound to '"0e di"#etes- usu"lly type 2 <omen .'o '"0e '"d gest"tion"l di"#etes '"0e " 3%&A9*& c'"nce o$ de0eloping di"#etes .it'in *A2* ye"rs (sing ne. di"gnostic criteri"- intern"tion"l multicenter study o$ gest"tion"l di"#etes $ound 8& o$ pregn"ncies .ere "$$ected
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Complications of Diabetes
=e"rt dise"se "nd stro,e =ypertension Flindness- eye pro#lems ?en"l dise"se Ner0ous system dise"se 2mput"tions !ent"l dise"se Complic"tions o$ pregn"ncy 8t'er complic"tions
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Complications of Diabetes 8eart Disease, Stro9e, 8ypertension

1n 2**4- o$ di"#etes-rel"ted de"t' certi$ic"tes "mong people "ges 59% ye"rs98& noted 'e"rt dise"se "nd 9&- sto,e 2dults .it' di"#etes '"0e 'e"rt dise"se de"t' r"tes 42A4 times 'ig'er t'"n t'ose .it'out6 stro,e ris, is 2A4 times 'ig'er 1n 2**%-2**8- o$ "dults "ges 52* ye"rs .it' sel$-reported di"#etes- 97& '"d #lood pressure 5 4*39* mm=g or used prescription medic"tions $or 'ypertension
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Complications of Diabetes :lindness, Eye Problems

!i"#etes is le"ding c"use o$ ne. c"ses o$ #lindness "mong "dults "ges 2*A74 ye"rs 8$ people .it' di"#etes "ged 54* ye"rs4.2 million :28.%&; '"d di"#etic retinop"t'y in 2**%-2**8 9%%-*** :4.4& o$ t'ose .it' di"#etes; '"d "d0"nced di"#etic retinop"t'y t'"t could le"d to se0ere 0ision loss

N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Complications of Diabetes (enal Disease

1n 2**8- di"#etes ."s le"ding c"use o$ ,idney $"ilure- "ccounting $or 44& o$ "ll ne. c"ses o$ ren"l $"ilure 48-374 people .it' di"#etes #eg"n tre"tment $or end-st"ge ren"l dise"se :ES?!; 2*2-29* people .it' ES?! due to di"#etes .ere li0ing on c'ronic di"lysis or .it' " ,idney tr"nspl"nt

N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Complications of Diabetes *er-ous System Disease

49*&A7*& o$ people '"0e mild to se0ere $orms o$ ner0ous system d"m"ge 1mp"ired sens"tion or p"in in $eet or '"nds Slo.ed digestion o$ $ood in t'e stom"c' C"rp"l tunnel syndrome Erectile dys$unction Se0ere $orms "re " m"jor contri#uting c"use o$ lo.er-e@tremity "mput"tions) >9*& occur in people .it' di"#etes
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Treatment of Diabetes
No medication 16% Insulin only 12%

Insulin and oral medication 14%

Oral medication only 58%

N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

Deaths 1mong People +ith Diabetes

1n 2**7- di"#etes se0ent' le"ding c"use o$ de"t' #"sed on de"t' certi$ic"tes 7 -382 underlying c"use 9*-*22 contri#uting c"use +i,ely to #e underreported "s " c"use o$ de"t' 80er"ll- ris, $or de"t' "mong t'ose .it' di"#etes is "#out t.ice t'"t o$ people .it' simil"r "ge #ut .it'out di"#etes

N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics- 2* . 20"il"#le "t) 'ttp)33di"#etes.nidd,.ni'.go03dm3pu#s3st"tistics3

1ge Distribution of Deaths 1ssociated +ith Diabetes

Age 18#!4 1, 18 1% Age "18 488 0% Age !5#44 5564 2% Age 45#54 16,66! Age 55#5 6% 1!, 07 5% Age 60#64 17,6!4 6% Age 65#6 20,656 7% Age 70+ 206,7 1 7!%

2meric"n !i"#etes 2ssoci"tion. Diabetes Care. 2**863 )%99-9 %. Figure 4.

Section 2

C!STS

Economic Costs of Diabetes, %&&7

Cost o$ !i"#etes /odel Eot"l cost o$ di"#etes) G 74 #illion G 9 #illion) e@cess medic"l e@penditures G27 #illion to tre"t di"#etes directly G%8 #illion to tre"t di"#etes-rel"ted c'ronic complic"tions "ttri#uted to di"#etes G3 #illion e@cess medic"l costs G%8 #illion) reduced n"tion"l producti0ity
2meric"n !i"#etes 2ssoci"tion. Diabetes Care. 2**863 )%99-9 %.

Medical E;penditures 1ttributed to Diabetes, %&&7

=ospit"l inp"tient c"re :%*&; !i"#etes medic"tion "nd supplies : 2&; ?et"il prescriptions to tre"t complic"tions o$ di"#etes : &; P'ysici"n o$$ice 0isits : &;

2meric"n !i"#etes 2ssoci"tion. Diabetes Care. 2**863 )%99-9 %.

Costs Incurred by People +ith a Diagnosis of Diabetes in %&&7

20er"ge "nnu"l e@penditures) G G9-949 "ttri#uted to di"#etes -744

8n "0er"ge- people .it' di"gnosed di"#etes '"0e medic"l e@penditures 42.3 times 'ig'er t'"n t'ose .it'out di"#etes 4G in G% 'e"lt' c"re doll"rs is spent c"ring $or someone .it' di"gnosed di"#etes 4G in G * 'e"lt' c"re doll"rs is "ttri#uted to di"#etes
2meric"n !i"#etes 2ssoci"tion. Diabetes Care. 2**863 )%99-9 %.

8ealth (esource Use 1ttributed to Diabetes, %&&7

2ge :ye"rs; =e"lt' resource Institutional care =ospit"l inp"tient d"ys Nursing3residenti"l $"cility d"ys Outpatient care 8$$ice-#"sed p'ysici"n 0isits Emergency 0isits =ospit"l outp"tient "nd $reest"nding "m#ul"tory surgic"l center 0isits =ome 'e"lt' 0isits =ospice c"re d"ys ?et"il prescriptions 74% 4%-94 59% Eot"lH

2- % -299 7-3%3 -499 -3*7 * 4

7-%89 - *3 29-%%2 -984 2-%3% 8-939 22 7 -29%

4-%92 43-987 3*-8*8 2-*84 -888 8-449 9% 88-84

24-292 %9-*%9 94-7 3 %-%97 %-73* 27-388 92 7%-3 7

%- 8

HNum#ers do not necess"rily sum to tot"ls #ec"use o$ rounding 2meric"n !i"#etes 2ssoci"tion. Diabetes Care. 2**863 )%99-9 %. E"#le %.

Indirect Costs 1ttributed to Diabetes, %&&7

Eot"l cost "ttri#ut"#le to di"#etes :G #illions; 2.9 2*.* *.8 7.9 29.9 %8.2 4 49 ** Proportion o$ indirect costs :&; 4 34

Cost component <or, d"ys "#sent ?educed per$orm"nce "t .or, ?educed producti0ity d"ys $or t'ose not in l"#or $orce Perm"nent dis"#ility /ort"lity Eot"l

Producti0ity loss % million d"ys 2* million d"ys 9 million d"ys 44%-*** people*7 million d"ys 284-*** de"t's

2meric"n !i"#etes 2ssoci"tion. Diabetes Care. 2**863 )%99-9 %. E"#le 4.

Mortality Costs 1ttributed to Diabetes, %&&7

!e"t's "ttri#uted to di"#etes I"lue o$ & o$ lost tot"l producti0ity o$ (S :millions o$ de"t's doll"rs; **.* %7.4 37.9 9.% N2H 9-%2* 29

Prim"ry c"use o$ de"t' !i"#etes ?en"l dise"se Cere#ro0"scul"r dise"se C"rdio0"scul"r dise"se Eot"l

Eot"l (S de"t's 77-*** 43-*** %%-*** 739-*** N2H

!e"t's 77-*** 2%-*** %9-*** 23-*** 284-***

3-849 -4 7 29-9*2

HEot"l comprises mort"lity $or re"sons ot'er t'"n t'ose listed 'ere

2meric"n !i"#etes 2ssoci"tion. Diabetes Care. 2**863 )%99-9 %. E"#le 9.

Economic Costs of Prediabetes and Diabetes, %&&7

=ig'er medic"l costs) G %3 #illion Producti0ity loss) G9% #illion Eot"l cost) G2 8 #illionJ G 74.4 #illion $or di"gnosed di"#etes G 8 #illion $or undi"gnosed di"#etes G2% #illion $or predi"#etes G939 million $or gest"tion"l di"#etes Eot"l #urden $or e"c' 2meric"n- reg"rdless o$ di"#etes st"tus) G7** "nnu"lly
!"ll E/- et "l. Health Affairs. 2* *629:2;)297-3*3.

(educing the :urden of Diabetes

Furden o$ di"#etes- complic"tions on indi0idu"ls- 'e"lt' c"re system signi$ic"nt /uc' o$ t'e cost is pre0ent"#le t'roug' 1mpro0ed diet "nd e@ercise Pre0ention initi"ti0es to reduce pre0"lence o$ di"#etes- comor#idities 1mpro0ed c"re $or people .it' di"#etes to reduce need $or costly complic"tions (nderst"nding economic cost- m"jor determin"nts o$ costs- c"n 'elp in$ormmoti0"te decisions to reduce #urden
2meric"n !i"#etes 2ssoci"tion. Diabetes Care. 2**863 )%99-9 %.

Section 3

FUTU(E P(!<ECTI!*S

IDF #lobal Pro ections for *umber of People +ith Diabetes, %&'&,%&=&

IDF Diabetes Atlas- 4t' ed. K1ntern"tion"l !i"#etes Feder"tion- 2**9.

Estimated *umber of People +ith Diabetes >orld+ide, %&'& and %&=&

Country3Eerritory 1ndi" 2 C'in" 3 (S2 4 ?ussi"n Feder"tion % Fr"Lil 9 Cerm"ny 7 P",ist"n 8 M"p"n 9 1ndonesi" * /e@ico 2* * Country3Eerritory /illions %*.8 43.2 29.8 9.9 7.9 7.% 7. 7. 7.* 9.8 1ndi" 2 C'in" 3 (S2 4 P",ist"n % Fr"Lil 9 1ndonesi" 7 /e@ico 8 F"ngl"des' 9 ?ussi"n Feder"tion * Egypt 2*3* /illions 87.* 92.9 39.* 3.8 2.7 2.* .9 *.4 *.3 8.9

IDF Diabetes Atlas- 4t' ed. K1ntern"tion"l !i"#etes Feder"tion- 2**9.

Modeling the Future U?S? :urden of Diabetes Through %&6&

Constructed system o$ dyn"mic eNu"tions 1niti"l pre0"lence :percent"ge o$ popul"tion .it' di"gnosed3undi"gnosed di"#etes; 1ncidence :percent"ge o$ popul"tion .it' ne.ly di"gnosed di"#etes; /igr"tion /ort"lity Pre0"lence o$ predi"#etes ENu"tions used to model $uture #urden o$ di"#etes on (.S. "dults t'roug' 2*%*
Foyle MP- et "l. Popul Health Metr. 2* *68)29.

1nnual U?S? Diabetes :urden in %&6&

Fy 2*%*- pre0"lence o$ tot"l di"#etes :di"gnosed "nd undi"gnosed; is projected to incre"se $rom in * "dults to #et.een in % "nd in 3 "dults 1ncidence) $rom 8 in *** to % in *** +"rgely "ttri#uted to t'ree ,ey $"ctors 2ging o$ t'e (.S. popul"tion 1ncre"sing siLe o$ 'ig'er-ris, minority popul"tions !eclining mort"lity "mong t'ose .it' di"#etes
Foyle MP- et "l. Popul Health Metr. 2* *68)29.

Total U?S? 1dult Population Diabetes Pre-alence Pro ections

Foyle MP- et "l. Popul Health Metr. 2* *68)29.