Report reveals cost of type 2 diabetes complications

A first-of-its-kind report looking at the prevalence and cost of type 2 diabetes complications shows that an estimated three out of five people (57.9 percent) with type 2 diabetes have at least one of the other serious health problems commonly associated with the disease, and that these health problems are taking a heavy financial toll on the United States.

In 2006, the nation spent an estimated $22.9 billion on direct medical costs related to diabetes complications.

The new report, titled State of Diabetes Complications in America, also shows that estimated annual healthcare costs for a person with type 2 diabetes complications are about three times higher than that of the average American without diagnosed diabetes. These complications, which can include heart disease, stroke, eye damage, chronic kidney disease and foot problems that can lead to amputations, cost a person with type 2 diabetes almost $10,000 each year. People with diabetes complications pay nearly $1,600 out of their own pockets for costs that are not reimbursed by insurance, such as co-payments and deductibles. This amount is significant, considering that according to the National Health Interview Survey, an estimated 40 percent of adults with diabetes reported a family income of less than $35,000 per year in 2005.

Results from the report were released at the American Association of Clinical Endocrinologists' (AACE) 16th Annual Meeting and Clinical Congress, by AACE in partnership with the members of a diabetes complications consortium: the Amputee Coalition of America, Mended Hearts, the National Federation of the Blind and the National Kidney Foundation, and supported by GlaxoSmithKline.

The State of Diabetes Complications in America is an analysis of national health and economic data specific to type 2 diabetes complications, and was developed as a follow-up to a 2005 AACE study showing that two out of three Americans with type 2 diabetes analyzed in a study had elevated blood sugar levels, which can lead to diabetes complications.

Many people with type 2 diabetes develop more than one health complication associated with the disease. The new report shows that an estimated one out of three people (33.3 percent) with the disease has one other serious health problem; one out of ten people (10.3 percent) with the disease has two other serious health problems; one out of 15 people (6.7 percent) with the disease has three other serious health problems; one out of 13 people (7.6 percent) has four or more other serious health problems.

"The report makes it clear that we have a major national issue when it comes to diabetes management, and that urgent action is needed," said Daniel Einhorn, MD, FACE, and Secretary of the Board of Directors of AACE. "People with type 2 diabetes need to achieve and maintain good blood glucose levels over time to improve their chances of reducing the risk of these serious complications."

The State of Diabetes Complications in America report synthesizes data from two large national studies to examine the issue of diabetes-related complications in the United States. Data on the prevalence of diabetes-related complications were derived from the National Health and Nutrition Examination Survey (NHANES) and combined with economic data from the Medical Expenditure Panel Survey (MEPS).

The report estimates that in people with diabetes, there are specific health problems that are more prevalent than in people with normal blood sugar levels. The prevalence of macrovascular problems, or those related to the heart and large blood vessels, in people with diabetes vs. people with normal blood sugar levels is as follows:

  • Congestive heart failure occurs in 7.9 percent of people with diagnosed diabetes vs. 1.1 percent of people without diabetes
  • Heart attack occurs in 9.8 percent of people with diabetes vs. 1.8 percent without diabetes
  • Coronary heart disease occurs in 9.1 percent of people with diabetes vs. 2.1 percent without diabetes
  • Stroke occurs in 6.6 percent of people with diabetes vs. 1.8 percent without diabetes

In terms of microvascular complications, which relate to small blood vessels, the prevalence is as follows:

  • Chronic kidney disease occurs in 27.8 percent of people with diabetes vs. 6.1 percent without diabetes
  • Foot problems such as foot/toe amputation, foot lesions and numbness in the feet occur in 22.8 percent of people with diabetes vs. 10 percent without diabetes
  • Eye damage occurs in 18.9 percent of people with diabetes (figures for eye damage in people without diabetes are not available in NHANES)

While type 2 diabetes is closely tied to the development of these complications, it is possible that some people may have developed these health problems independent of their diabetes, due to family history or other underlying medical conditions.

"Beyond the impact on quality of life, health complications from type 2 diabetes also contribute to substantial national and individual healthcare costs," said Willard G. Manning, PhD, Professor, Harris School of Public Policy Studies at the University of Chicago. "My hope is that the report will call attention to the issue of diabetes-related complications and bring about change in the way we manage type 2 diabetes to help reduce both the physical and financial burdens."

Regarding annual healthcare costs for people with type 2 diabetes, heart attack is the most costly complication, at $14,150 per person, followed by chronic kidney disease (3) ($9,002); congestive heart failure ($7,932); stroke ($7,806); coronary heart disease ($6,062); foot problems ($4,687); and eye damage (5) ($1,785).

"As great as these financial burdens are, this is a conservative estimate, as it only includes direct medical costs," adds Manning. "Costs attributed to lost employment or productivity, premature death and disability have not been included, and if we factor in those costs, the overall burden would be far greater."

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