Diabetes

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In 2006, diabetes was listed as the underlying cause of death on more than 70,000 death certificates. In 2005, diabetes was reported to contribute to more than 230,000 deaths, which makes it the 7th leading cause of death.

Complications:

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◦Heart disease, stroke, high blood pressure

◦Blindness

◦Kidney disease

◦Neuropathy

Costs:

Costs of care for diabetes $218 billion

Direct and indirect costs: $174 billion

Additional $43.6 billion in undiagnosed, pre-diabetes, and gestational diabetes

In 2015, diabetes was listed as a contributing factor in cause of death on more than 252,806 death certificates. Diabetes remains the 7^th leading cause of death in the US.

-There are a number of complications of diabetes that contribute to mortality and diminished quality of life. Heart disease and stroke deaths are between 2-4 times higher for people with diabetes than people without diabetes.

-Around 73.6% of adults with diabetes in 2011-2014 had hypertension.

- Diabetic retinopathy accounts for between 12,000 and 24,000 new cases of blindness each year and is the leading cause among 20-74 year olds.

-In 2014, a total of 52,159 people developed end-stage renal disease with diabetes as the primary cause.

-Diabetes is also commonly associated with mild to severe neuropathy. It should also be noted that most of the non-traumatic lower-limb amputations occur in people with diabetes, totaling nearly 108,000 cases in 2014. Other complications include increased risk for dental disease, complications of pregnancy, physical limitations, and higher death rates from other diseases and conditions.

It is important to note, that while public awareness of diabetes and related complications has increased, and medications and treatments have expanded, all of these complication statistics have also increased in both number and rate over the last 10 years. Diabetes is clearly not a disease that can be improved simply by screening and diagnosis. Treatment adherence is central to reducing complications and deaths.

Costs

People with diabetes spend, on average about 2.3 times more for their medical care than for people without diabetes. The 2017 per capita cost of healthcare for a person with diabetes was $13,700 per year, 57% of which was directly attributed to diabetes. These numbers translate to 1 in every 5 health care dollars being spent on someone with diabetes, and 1 in every 10 health care dollars being spent attributable to diabetes.

The total direct and indirect estimated cost of diagnosed diabetes in the United States in 2012 was $245 billion

Medical costs, unemployment, and disability driven by uncontrolled diabetes are major public resource uses.

Treatments

Prevention of progression to diabetes Treatment for diagnosed diabetes •Diet and exercise •Insulin and/or oral hypoglycemic agents •Medication for risk reduction •Self-management education/timing

An impaired glucose tolerance test result and fasting glucose that is higher than normal, but not high enough to diagnose diabetes, is a condition called pre-diabetes. There is an increased health risk for people with pre-diabetes for developing type 2 diabetes, heart disease, and stroke. However, the progression to type 2 diabetes is not inevitable. Prevention is based on efforts in people who are obese to reduce their weight and increase their physical activity. In one study, the Diabetes Prevention Program, lifestyle changes appeared to reduce the progression to diabetes for nearly 60% of participants over a three year period, and over 70% for 60 years and older adults. Lifestyle changes are more cost effective than medications with fewer potential side effects.

The treatments for diabetes center on controlling blood sugar levels and reducing the effects of some complications such as high blood pressure and high blood lipids. According to the CDC, each percentage point drop in the measure of hemoglobin A1c reduces the risk of kidney disease and neuropathy by up to 40%. Control of blood lipids can decrease cardiovascular complications from 20% to 50%. Control of blood pressure can reduce complications related to vascular problems between 33-50%. Each 10mm (millimeter or Hg) mercury drop in blood pressure can reduce the risk for any complication by about 12%.

Self management training is an important part of reducing the impact of diabetes. These care skills include foot care, self monitoring of blood glucose, understanding of blood glucose factors, understanding of causes of blood sugar changes and adherence to diabetes care and treatment recommendations.