The Burden of Diabetes

The Burden of Diabetes

Epidemiology

Diabetes affects 8.3% of the population of the United States, or approximately 25.8 million people. Of these, 7 million have not been diagnosed. Approximately 90% of all diabetes cases are type 2 diabetes.1

In addition, another 79 million people—35% of US adults—have prediabetes,which raises short-term absolute risk of type 2 diabetes by 3- to 10-fold.1-3 Overall, up to 70% of people with prediabetes may develop type 2 diabetes during their lifetimes.4 Thus, the prevalence of diabetes is projected to double in the next 10 years and, if current trends continue, this may affect 100 million people by 2050.5

Both the prevalence of diabetes and the risk of developing the disease vary widely with ethnicity. Among adults aged 20 years and older, the prevalence of diabetes is as follows:1

  • Non-Hispanic whites: 7.1%
  • Asian Americans: 8.4%
  • Hispanic Americans: 11.8%
  • African Americans (ie, non-Hispanic blacks): 12.6%
  • Native Americans: 16.1%

The rate of diabetes also varies within specific populations. For example, only 5.5% of Alaskan Natives have diabetes, compared with 33.5% of American Indians from southern Arizona. Among Hispanics, 7.6% of Cubans and Central and South Americans, 13.3% of Mexican Americans, and 13.8% of Puerto Ricans have diabetes.1

The difference in diabetes prevalence among various ethnic groups may reflect differences in their susceptibility to the disease. South Asians are more than 3 times as likely to develop diabetes as whites, whereas black and Hispanic populations are approximately twice as likely.6,7 The onset of diabetes in these groups also occurs at a lower BMI than it does in whites.6

Diabetes and Youth

As the obesity rate has risen among young people, so has the rate of type 2 diabetes in the young. While the overall incidence of type 2 diabetes in patients 10 to 19 years of age remains substantially lower than that of type 1, it is on the rise, especially among nonwhite youth. Among African Americans, approximately half of all new cases were type 2 diabetes, whereas among Asians and Native Americans, the majority of new diabetes cases were type 2.1

Morbidity and Mortality

Diabetes is associated with high rates of mortality and morbidity. Relative to people without diabetes, the disease:1

  • Doubles the risk of death from any cause
  • Doubles to quadruples the risk of death from cardiovascular disease
  • Doubles to quadruples the risk of stroke

Diabetes is also a leading cause of adverse health problems in the United States:1

  • Diabetes is the
    • Seventh leading cause of death, according to death certificate data (which may be an underestimate)
    • Leading cause of blindness among adults
    • Leading cause of kidney failure.
  • More than 60% of nontraumatic lower limb amputations occur in people with diabetes.
  • Diabetes doubles the risk of periodontal disease.
  • Diabetes doubles the risk of developing depression, and depression increases the risk of diabetes by 60%.
  • Diabetes increases patients’ susceptibility to acute infections and illnesses such as pneumonia and influenza and worsens the prognosis of patients with these conditions.

Costs

In the United States, the direct and indirect costs of diabetes are staggering:1

  • Direct costs: $116 billion
  • Indirect costs: $58 billion
  • Indirect costs include disability, work loss, and premature mortality, whereas direct costs include medications, visits with healthcare providers, and hospitalizations. After adjusting for age and sex, medical expenditures among people with diagnosed diabetes were, on average, 2.3 times higher than expenditures among those without diabetes.1

    References

  1. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.
  2. Haffner SM, Mykkanen L, Festa A, Burke JP, Stern MP. Insulin-resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects: implications for preventing coronary heart disease during the prediabetic state. Circulation. 2000;101:975-980.
  3. Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005;112:3066-3072.
  4. Nathan DM, Davidson MB, DeFronzo RA, et al. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care. 2007;30:753-759.
  5. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.
  6. Chiu M, Austin PC, Manuel DG, Shah BR, Tu JV. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. Diabetes Care. 2011;34:1741-1748.
  7. Lorenzo C, Hazuda HP, Haffner SM. Insulin resistance and excess risk of diabetes in mexican-americans: the san antonio heart study. J Clin Endocrinol Metab. 2012;97:793-799.