The Basic Statistics regarding Diabetes

Just how big a problem is diabetes in the United States and probably in other developed countries as well? It’s a huge problem, as you might be discovering in this audiobook already, and it is a problem that is increasing in incidence as the people in our nations become fatter and more sedentary. More than seven million people alone out of the 30 million people total do not even know they have it, even though they are at just as great a risk for complications as those who know they have it.

About a fourth of all people over the age of 65 years have diabetes. Almost all of these have type 2 diabetes, partly because type 1 diabetics often don’t even live that long unless they are aggressively treated. More than 1.5 million new cases of diabetes are identified in the United States each year, mostly because of testing done at the doctor’s office when they have no symptoms of the disease.

Diabetes is considered the seventh leading cause of death in the United States, although this number is probably artificially low because patients with diabetes often die of diabetic-induced complications listed on their death certificate as the main cause of death without diabetes being mentioned on the death certificate. In 2015 alone, researchers identified nearly 80,000 death certificates listing diabetes as the major cause of death. Three times as many or about 250,000 death certificates included diabetes as a factor that contributed to the person’s death. As we’ve already mentioned, diabetes is a risk factor for other diseases that are more deadly than dying from high blood sugar by itself.

Young people have a chance of either type of diabetes. About 190,000 people under the age of 20 in the United States have known diabetes, which is only one-fourth of one percent of young people. That number, however, is expected to rise in the coming years—not because the incidence of type 1 diabetes is going up but because of higher numbers of type 2 diabetics being discovered. Just ten years ago, about 17,900 juveniles in America had type 1 diabetes, while 5300 had type 2 diabetes.

Only 5300 young people with type 2 diabetes doesn’t sound like many but, in a 2012 research study published in the American Diabetes Association journal called Diabetes Care, these numbers probably represent just the beginning of the epidemic of type 2 diabetes. In the study, they estimated that the number of diabetes cases in young people could be up to 50 percent higher than they are now by the year 2050, and that’s only if the rise in incidence stays the same. If the rate of increase worsens, the number of cases could go up fourfold during that same time period.

As you will later learn, the risk of developing type 2 diabetes depends on what your race or ethnicity is. This is based on hereditary factors that are not completely understood.

Non-Hispanic whites have diabetes at a rate of about 7.4 percent, with Asians, especially Filipinos, having a slightly higher risk. The risk goes up to more than 12 percent in Hispanics and in non-Hispanic blacks. Mexican-Americans have a higher risk than other Hispanic ethnicities. Among Hawaiians, 41 percent have prediabetes and 13 percent have type 2 diabetes. American Indians and Alaskan Natives have the highest risk of all, with diabetes found in more than 15 percent of the population.

As a disease, diabetes is very costly in ways unrelated to death from the disease itself. A March 2018 study by the American Diabetes Association indicated that the total costs of

diabetes in the United States is about $327 billion dollars. This compares with costs just five years earlier of just $245 billion dollars per year or about a 26 percent increase in total monetary burden of this disease.

Some of these costs are related to the direct costs of managing the disease and its complications, estimated to be about $237 billion dollars per year. Other costs are harder to measure but represent the costs related to reduced productivity, which is the dollars lost by people and the community in general when the diabetic can no longer work to support themselves due to illness or disease complications. This is believed to be about $90 billion dollars a year.

Diabetics are hospitalized more often than the general population, accounting for 30 percent of the total direct medical costs of the disease. Prescriptions alone used to treat just the complications of diabetes are responsible for another 30 percent of the total costs incurred. Diabetic supplies and other anti-diabetic treatments add up to 15

percent of the cost and visits to the doctor in order to manage diabetes add up to 13 percent of the total cost.

For the person with diabetes, this means spending about $17,000 dollars a year for medical treatment, more than half of which is directly related to having diabetes. This is more than double what the person without diabetes has to pay for their treatment each

year.

Of course, the diabetic alone doesn’t only pay this price. When the insurance companies, Medicare, and Medicaid are responsible for these high costs, the real cost is everyone’s problem because it means higher taxes, higher insurance premiums, and a higher economic burden for the entire country. If 25 percent of all healthcare dollars are spent on diabetes in the US, which is the current estimate, you can bet that everyone in the country pays some of these costs.

Indirect costs due to diabetes are related to several things. Diabetics in the workforce miss work more often than those who do not have diabetes, accounting for billions of dollars lost. Even when they work, their productivity is lower, which is also costly to everyone. Those who cannot work at all often receive some type of disability benefit from the government and do not contribute to the overall productivity of the country in general. Finally, there are the losses incurred when a diabetic dies prematurely, leaving their family without the necessary income to support themselves and, again, everyone pays the price.

In fact, more than two-thirds of all of the cost for diabetic care comes directly from the US government, which includes programs like Medicaid, Medicare, and military health programs. The remainder is paid for through private insurance companies. Those who have diabetes but no insurance coverage see the doctor less often and take fewer medications for their diabetes but have 168 percent more visits to the emergency department for complications than those who do have health insurance. States like California, Texas, Florida, and New York bear the greatest financial burden of this disease.

To summarize this section of the audiobook, it is probably safe to conclude that diabetes mellitus is just an umbrella term for a number of related metabolic diseases and that it

is a serious disease, costing this country and others billions of dollars per year in direct and indirect costs related to having it. Its incidence in the US is increasing and the burden to our economy and collective health will only increase further unless something is done to reduce the risks of developing it.

THINGS TO REMEMBER FROM THIS SECTION

• There are several types of diabetes, affecting about 30 million Americans.

• Type 1 diabetes is an autoimmune disease that destroys the ability of the pancreas to make insulin.

• Type 2 diabetes represents up to 95 percent of all cases; is related to insulin resistance and to an inability of the cells to respond to existing insulin levels in the bloodstream.

• Type 2 diabetes is partly genetic and partly related to lifestyle; certain ethnicities are at a higher risk of developing the disease.

• Gestational diabetes is diabetes that occurs only in pregnancy and is related somehow to having insulin resistance during this time.

• MODY or Maturity Onset Diabetes of the Young is a genetic cause of diabetes related to gene defects that affect half of all of the affected person’s children later in their life.

• Diabetes is the seventh leading cause of death officially but this number is probably inaccurate because diabetes is the underlying risk factor for other diseases a person can die from.

• Diabetes is very costly, both in the direct costs of treating the disease and in the indirect costs related to lost work productivity, disability, and premature death from having diabetes.