The Burden of Diabetes

The Burden of Diabetes

Epidemiology

Diabetes affects 9.4% of the population of the United States, or approximately 30.3 million people. Of these, 7.2 million have not been diagnosed. Approximately 90% of all diabetes cases are type 2 diabetes.1

In addition, another 84 million people—34% 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 race, ethnicity, and sex (see Burden of Diabetes slide deck).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 American, Asian, Hispanic, and Native American people younger than 20 years of age, the majority of new diabetes cases are type 2.1

Morbidity and Mortality

Diabetes is the seventh leading cause of death in the United States and is associated with high rates of hospitalization and/or treatment for cardiovascular and kidney disease.1

Cost

In the United States, the direct and indirect costs of diabetes are staggering:8

  • Direct costs: $176 billion
  • Indirect costs: $69 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.8

References

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017.
  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.
  8. 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;37:3172-3179.