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Diabetes Care Will Cost $336B by 2034

Posted: Saturday, January 29, 2011

More than 44 million Americans will have diabetes within 25 years under current trends, and the annual cost of caring for them will triple to $336 billion in constant 2007 dollars.

Elbert S. Huang, MD, MPH, of the University of Chicago, and colleagues reported that, the obesity epidemic, ever-earlier ages of diabetes onset and increasing longevity of people with established diabetes are combining to enlarge the diabetic population far beyond anything envisioned in earlier projections.

"Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened healthcare system," the researchers warned.

Currently, some 24 million Americans are living with diabetes, Huang said in a briefing for reporters. "Already this represents a great economic burden for the country and for government programs like Medicare," he said.  Huang and colleagues estimated that costs to Medicare would rise nearly fourfold, from about $45 billion currently to $171 billion in 2034, in constant dollars.

Previous forecasts had projected slower growth in the number of diabetic patients. For example, a 2001 study by CDC researchers estimated that about 29 million Americans would be diagnosed with the disease in 2050.

Unlike earlier efforts, Huang and colleagues included trends related to obesity in their model for projecting future cases of diabetes, as well as data from the 2004 United Kingdom Prospective Diabetes Study (UKPDS) on the natural history of the disease.

The UKPDS data allowed the researchers to develop a model by which individuals with certain disease durations and ages were expected to have developed corresponding levels of cardiovascular, renal, ocular, and other complications.

"We know that the average cost of treating diabetes in newly diagnosed people is substantially different from the costs of treating someone who has lived with diabetes for 20 or 30 or 40 years and is suffering from microvascular or cardiovascular complications," Huang explained.

Data from the U.S. government's Medical Expenditure Panel Survey were used to attach treatment costs to care of diabetes and the associated complications at different patient ages and disease durations.

"Our model accounts for that natural history and the change in the life of a patient," he said. That is why the study forecast more rapid increases in costs than in the diabetic population -- because patients are living longer with these expensive complications.

The study also took account of trends in body mass index distribution. According to the group's projections, "overall obesity distribution in the nondiabetes population remains fairly stable over time, with about 65% of the population being overweight or obese."

Some 35% of the population will be overweight throughout the period, while the percentage classed as obese will decline from 30% currently to 27% by 2034, the researchers said.

The obesity projections were based on UKPDS and U.S. data on how body mass index changes with age. Actual obesity prevalences could be higher or lower if eating and exercise habits or anti-obesity medical treatments change significantly.

The current study did not analyze the potential effects of interventions aimed at reducing the incidence and severity of diabetes. But Huang said small-scale programs promoting healthy eating and exercise have shown the ability to affect the natural history of diabetes.

Matt Petersen, a spokesman for the American Diabetes Association, said "Realistic and achievable amounts of changes in diet and physical activity do have a clinically significant effect on primary prevention."

But Huang acknowledged that, outside of formal clinical studies, "it's not clear that... community efforts are collectively making a big impact in terms of diabetes prevention."

On the other hand, he said data from the CDC's National Health and Nutrition Examination Survey indicate that blood glucose, cholesterol, and blood pressure control may be improving. "I don't know if that's attributable to community efforts as much as to physician and patients becoming more aware of targets for diabetes care and slightly better delivery of drugs," Huang said. "I would say that the story is mixed in terms of diabetes prevention and diabetes care.

The researchers noted several limitations to their analysis:

    * It did not account for possible future changes in diabetes screening rates, which could raise or lower the numbers of people receiving treatment.
    * It did not account for immigration by people younger than 24.
    * All individuals with body mass index values of 30 and higher were grouped together, leading to potential underestimation of the future diabetic population and costs.
    * The model assumed no change in baseline age-specific rates of obesity.

Practice Pearls:

    * Explain to interested patients that the prevalence of diabetes in the U.S. has been growing and is projected to continue to grow, with an increasing cost burden as well.

    * Explain that the predictive model used in the study did not address potential interventions that could prevent diabetes or slow the development of complications.

Source: http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=10426&catid=53&Itemid=8, Huang E, et al "Projecting the future diabetes population size and related costs for the U.S." Diabetes Care 2009; 32: 2225-29.

 
 
 
 
 
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