Current Burden of Diabetes in the U.S.
Diabetes is one of the most common and costly chronic diseases. An estimated 23.1 million people in the United States are diagnosed with diabetes at a cost of more than $245 billion per year.1,2 The CDC estimates that another 7.2 million people have diabetes but remain undiagnosed, while another 84.1 million adults 18 years and older have prediabetes.1 The highest rates of diabetes are found among minority populations and older Americans; however, across the United States, the overall prevalence continues to increase as overweight and obesity rates rise.3 Individuals with diabetes are at greater risk than other similar adults for many common problems, including coronary heart disease, stroke, hypertension, depression, pain, polypharmacy, and functional disability.4 Diabetes remains the leading cause of new cases of blindness among adults in the United States, and the leading cause of end-stage renal failure. Annual updates on the impact of diabetes on the health of the U.S. population are available from the CDC National Diabetes Statistics Report.
Despite significant advances in therapy over the past several years, diabetes remains the seventh leading cause of death in the United States. Intensive treatment of glucose, blood pressure, and lipid levels in individuals with diabetes substantially reduces the risk of developing diabetes-related complications. However, under current models of care, many individuals with diabetes are not achieving the targets for optimal care recommended by clinical experts. In the most recent reports from the National Committee for Quality Assurance on health maintenance organizations (HMOs), 31 percent of patients continue to have an A1C greater than 9 percent, while 35 percent have blood pressure of ≥140/90 mm Hg.5 This gap between current ‘best practice’ and current performance results in costly consequences in population health.
Despite huge investment, the health of the U.S. population lags behind other developed countries in life expectancy, infant mortality, and disease-related deaths.6 Although the United States performs better in the delivery of diabetes care—ranking 4th among 11 leading developed countries7—the United States needs to enhance the delivery of services to provide better support for individuals with diabetes, particularly in light of the rapidly rising rates of diabetes and an aging population.
Health care costs, outcomes, and physician burnout are a few factors influencing a need to transform the delivery of diabetes care. The estimated diabetes cost in the United States in 2012 was $245 billion, including $176 billion for direct medical costs and $69 billion in indirect costs, such as disability, time lost from work, and premature death.2
Computer modeling has shown that, compared to standard treatment, early, effective diabetes management can reduce treatment costs for diabetes complications of the eye, kidney, and extremities.8 There is a marked correlation between glycemic control and the cost of medical care, with medical charges increasing significantly for every 1 percent increase in A1C above 7 percent.9 The increase in medical charges accelerates as the A1C value increases.
As the U.S. health care delivery system and the field of medicine have changed, considerations also arise when it comes to the toll on physicians. A number of factors, such as more onerous certification requirements, increased administrative burdens, new and evolving regulatory requirements, and increased scrutiny around quality metrics, are contributing to physician burnout.10
Appropriate control of A1C, blood pressure, and cholesterol, and better screening for eye disease, neuropathy, and renal disease, improve clinical outcomes.11,12 Individuals with prediabetes who successfully adopt lifestyle changes lower their risk of developing type 2 diabetes.13 By redesigning diabetes care services in the primary care setting and moving to team-based care, health care providers and practices may successfully increase the number of patients meeting recommended targets or enhance screening rates for preventive interventions, which may, in turn, improve the health of the population and reduce the serious impact of diabetes, while concurrently decreasing burnout and improving provider joy.