In a 2007 study published by the American Diabetes Association, authors Judith Fradkin and Griffin P. Rodgers warned of the growing cost of diabetes and the economic burden it would inflict upon the U.S. The report reads:
The new data presented in this issue estimating the 2007 economic cost of diabetes in the U.S. at $174 billion are sobering. One in five health care dollars is spent caring for someone with diabetes, and one in ten dollars spent on health care is attributable to diabetes and its complications. In addition to the $116 billion in excess medical expenditures, the loss to the nation in economic productivity is $58 billion.
Fast-forward five years to 2012 where the total estimated cost of diagnosed diabetes is $245 billion and totals $322 billion when lost productivity due to illness is added to the equation. That means the cost of diabetes has nearly doubled, coming out to a 48 percent cost increase in only five years. That’s a cost of $1,000 per year for every American, even those without diabetes.
Despite the sometimes dire warnings issued by the medical community, the prevalence of diabetes has not decreased. The costs of diabetes — both human and economic — are well known, so why does the rate of the disease continue to climb?
A growing population
Since 2007, diabetes treatment programs have remained largely unchanged while the rates of two main risk factors — obesity and old age — have risen. As America’s population grows, similarly, rates of diabetes will rise. On top of America’s increasing population, the percentage of Americans who are age sixty-five and older is climbing, as the baby boomer generation enters their later years.
Diabetes disproportionately affects older adults; a staggering 25 percent of adults age 60 and older have the disease. Without a significant strategy change in the public or private sectors, population growth on top of skyrocketing medical costs and an aging population will add an unbearable strain to an already overburdened healthcare system. These grim numbers accentuate the growing need for new strategies that will not simply react to the disease and manage symptoms, but prevent the disease from happening.
The danger of prediabetes
Diabetes does not occur without any warning signs. Before someone’s blood sugar raises to a diabetic level, they will first develop prediabetes, a condition where blood sugar is elevated, but not yet high enough to be considered diabetes. 86 million adults, or 37 percent of the adult population, have prediabetes. Prediabetes is largely influenced by weight and age, which, as described above, are both on the rise.
Prediabetes is reversible, and with the right treatment, many prediabetics will never develop diabetes. But with current treatment, 25 percent of prediabetics will develop diabetes within 3-5 years, while up to an incredible 70 percent will develop diabetes long-term. What’s even more shocking, is that a mere 6.8 percent of people diagnosed with diabetes in 2011 or 2012 were given diabetes self-management training, according to the CDC.
A lack of scalable treatment
In order to reverse the current trajectory, we must find a way to scale lifestyle treatments. As previously stated, only 6.8% of diabetic patients are receiving lifestyle change treatments; of the patients receiving treatment, most are likely enrolled in an in-person program. An in-person program, like the CDC’s National Diabetes Prevention Program, is extremely effective and can reduce risk of diabetes by 58 percent. If a program like the NDPP were able to reach people in the context of their own homes, its reach could be extended while a higher-touch experience could create greater success.
Currently, the most widely used diabetes treatment is oral medications that control blood sugar. While there is no shortage of diabetes medication, costs can range from $4 to $500 a month. Aside from the high cost, the New England Journal of Medicine found that lifestyle changes were twice as effective as diabetes medication. Preventative lifestyle change programs do exist but they do not have the ability to scale across large populations. In order to reverse the course of diabetes, we must find a way to scale an engaging program, like the NDPP, across populations. It is vital that we change course now, and treat prediabetes and early-stage diabetes when the disease can still be reversed, to save our current healthcare system, billions of dollars, and countless lives.
In part two of this series, we will explore the best ways to identify high-risk patients and treat prediabetes, preventing it from progressing to diabetes.