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Current Burden of Diabetes in the U.S.

Diabetes is one of the most common and costly chronic diseases. An estimated 20 million people in the United States are diagnosed with diabetes at a cost of more than $245 billion per year.1 The CDC estimates that another 8.1 million people have diabetes but remain undiagnosed, while another 86 million adults 20 years and older have prediabetes.2 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 U.S., 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 o f ≥140/90 mm Hg.5 This gap between current ‘best practice’ and current performance results in costly consequences in population health.

Why Change?

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 U.S. performs better in the delivery of diabetes care—ranking 4th among 11 leading developed countries7— the U.S. 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. Appropriate control of A1C, blood pressure, and cholesterol, and better screening for eye disease, neuropathy, and renal disease improve clinical outcomes.8,9 Individuals with prediabetes who successfully adopt lifestyle changes lower their risk of developing type 2 diabetes.10 By redesigning diabetes care services in the primary care setting, 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.

References

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf (PDF, 5.31 MB).
2. Dall TM, Yang W, Halder P, et al. The economic burden of elevated blood glucose levels in 2012: diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care. 2014;37(12):3172-9.
3. CDC's Division of Diabetes Translation. (2015). Maps of Trends in Diagnosed Diabetes and Obesity. Centers for Disease Control, National Surveillance System, Retrieved from http://www.cdc.gov/diabetes/statistics/slides/maps_diabetes_trends.pdf (PDF, 461 KB).
4. American Diabetes Association. (2015). Standards of Medial Care in Diabetes - 2015. Diabetes Care, 38 Suppl. (January), S17–19. doi:10.2337/dc15-S00511.
5. National Committee for Quality Assurance (NCQA). (2015). State of Health Care Quality 2015. USA. Retrieved from http://healthinsuranceratings.ncqa.org/2015/Default.aspx
6. Chen S. Singapore Beats Hong Kong in Health Efficiency: Southeast Asia [Internet]. Bloomberg Business. 2014 [cited 2015 May 27]. Available from: http://www.bloomberg.com/visual-data/best-and-worst//most-efficient-health-care-2014-countries
7. Davis, K., Schoen, C., & Stremikis, K. (2008). Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares Internationally, 2010 Update (New York: The Commonwealth Fund, June 2010).
8. UK Prospective Diabetes Study Group (UKPDS). (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet, 352(9131), 837–853.
9. Diabetes Control and Complications Trial Research, G. (1993). Effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329(14), 977–986.
10. Knowler, W. C., Fowler, S. E., Hamman, R. F., Christophi, C. a, Hoffman, H. J., Brenneman, A. T., Nathan, D. M. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374(9702), 1677–86. doi:10.1016/S0140-6736(09)61457-4.

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