Diabetes Cases Expected to Double in 25 Years
Soaring rates to bring unprecedented medical, economic burdens, study predicts.
By Jennifer Thomas
FRIDAY, Nov. 27 (HealthDay News) -- The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.
That would bring the total by 2034 to about 44.1 million people with the disease, up from 23.7 million today.
At the same time, the cost of treating people with diabetes will triple, the study also warns, rising from an estimated $113 billion in 2009 to $336 billion in 2034.
One factor driving the soaring costs: the number of people living with diabetes for lengthy periods, the researchers said. Over time, the cost of caring for someone with diabetes tends to rise along with their risk for developing complications, such as end-stage renal disease, which requires dialysis.
"We believe our model provides a more precise estimate of what the population size will look like and what it will cost the country and government programs like Medicare," said study author Dr. Elbert Huang, an assistant professor of medicine at the University of Chicago.
Prior forecasts, including the ones currently used by the federal government's budget analysts, have underestimated the burden, the researchers said. A 1991 study, for example, predicted that 11.6 million people would have diabetes in 2030. In 2009, there were already more than twice that many living with diabetes.
"In a similar way, we may be underestimating what's happening, which is actually very disturbing," Huang said.
Among Medicare beneficiaries, the number with diabetes is expected to rise from 8.2 million to 14.6 million in 2034, with an accompanying rise in spending from $45 billion to $171 billion.
"That essentially means that in 2034, half of all direct spending on diabetes care will be coming from the Medicare population," Huang said.
The study is published in the December issue of Diabetes Care.
The high cost of chronic disease is one of the most pressing issues facing the United States as legislators grapple with financial strains on Medicare and the larger issue of health-care reform, the researchers say.
Factors driving the increase in diabetes cases include the aging population and continued high rates of obesity, both of which are risk factors for type 2 diabetes, in which the body does not produce enough insulin or the cells don't use it correctly. In the study, the researchers assumed that the obesity rate would remain relatively stable, topping out at about 30 percent in the next decade and then declining slightly to about 27 percent in 2033.
Dr. David Kendall, chief scientific and medical officer for the American Diabetes Association, said the study is one of several recent papers predicting a dramatic rise in the incidence of diabetes. And though which methodology provides the most accurate predictions is open to debate, he said, the overarching message is that steps need to be taken to prevent diabetes from overwhelming an already overburdened health-care system.
"This is, in a sense, evidence of an iceberg," Kendall said. "What we are seeing currently is only a fraction of the potential future risk."
In making their estimates, the researchers used data on people 24 to 85 years old who took part in the U.S. Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and the National Health Interview Study.
"This is clearly a very pressing problem," said study co-author Michael O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago. "It's one of the few chronic illnesses we have that is growing, and the cost of doing nothing is going to be quite high."
Matt Peterson, director of information resources at the American Diabetes Association, said that community-based intervention programs that include dietary counseling and exercise, such as walking for 30 minutes most days of the week, can help combat the trend.
"We're not talking about massive weight loss or for everyone to become marathon runners," Peterson said. "We are talking about modest weight loss of 10 to 15 pounds. It's a challenge, but it's an achievable goal."
For those with diabetes, the American Diabetes Association recommends modest weight loss, increased physical activity, maintaining A1C (blood sugar) levels below 7, cholesterol control and blood pressure control to prevent complications.
The American Diabetes Association has more on living with diabetes.
SOURCES: Elbert Huang, M.D., assistant professor, medicine, University of Chicago Medical Center, Chicago; Michael O'Grady, Ph.D., senior fellow, National Opinion Research Center, University of Chicago; Matt Peterson, director, information resources, American Diabetes Association, Alexandria, Va.; David Kendall, M.D., chief scientific and medical officer, American Diabetes Association, Alexandria, Va.; December 2009 Diabetes Care
Copyright 2009 HealthDayNews, Inc. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Projecting the Future Diabetes Population Size and Related Costs for the U.S.
1. Elbert S. Huang, MD, MPH1,
2. Anirban Basu, PHD1,
3. Michael O'Grady, PHD2 and
4. James C. Capretta, MA3
+ Author Affiliations
1. 1Department of Medicine, University of Chicago, Chicago, Illinois;
2. 2National Opinion Research Center at the University of Chicago, Chicago, Illinois;
3. 3Civic Enterprises, Washington, DC.
1. Corresponding author: Elbert S. Huang, firstname.lastname@example.org.
OBJECTIVE We developed a novel population-level model for projecting future direct spending on diabetes. The model can be used in the federal budget process to estimate the cost implications of alternative policies.
RESEARCH DESIGN AND METHODS We constructed a Markov model simulating individuals' movement across different BMI categories, the incidence of diabetes and screening, and the natural history of diabetes and its complications over the next 25 years. Prevalence and incidence of obesity and diabetes and the direct spending on diabetes care and complications are projected. The study population is 24- to 85-year-old patients characterized by the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and National Health Interview Survey.
RESULTS Between 2009 and 2034, the number of people with diagnosed and undiagnosed diabetes will increase from 23.7 million to 44.1 million. The obesity distribution in the population without diabetes will remain stable over time with ?65% of individuals of the population being overweight or obese. During the same period, annual diabetes-related spending is expected to increase from $113 billion to $336 billion (2007 dollars). For the Medicare-eligible population, the diabetes population is expected to rise from 8.2 million in 2009 to 14.6 million in 2034; associated spending is estimated to rise from $45 billion to $171 billion.
CONCLUSIONS The diabetes population and the related costs are expected to at least double in the next 25 years. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system.
* The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
* o Received March 9, 2009.
o Accepted August 12, 2009.
* (c) 2009 by the American Diabetes Association.
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