The steady march of diabetes and costs we all bear

A CDC study released yesterday showed that during the period January-June 2007, 7.5% (95% confidence interval = 6.96-8.05%) of American adults (aged 18 years and over) have been diagnosed as having diabetes. Although the figure is not significantly different from the 2006 estimate of 7.8%, it is too early to tell whether the increasing numbers of diagnosed cases of diabetes have begun to level off, or whether the upward trend will continue. From 1997 through 2006, there was an increasing trend in the percentage of adults diagnosed with diabetes, from 5.1% in 1997 to 7.8% in 2006.

What does this mean for health insurance? According to the National Diabetes Information Clearing House, a service of the National Institutes of Health, the direct medical and indirect expenditures attributable to diabetes in 2002 were estimated at $132 billion.

Direct medical expenditures alone totaled $91.8 billion. This whopping figure can be broken down further (see source article):

• $23.2 billion went for diabetes care, $24.6 billion went for chronic complications attributable to diabetes, and $44.1 billion went for excess prevalence of general medical conditions);
• The three major expenditure groups by service settings were inpatient days (43.9% of spending), nursing home care (15.1% of spending), and office visits (10.9% of spending);
• 51.8% of direct medical expenditures were incurred by people under 65 years old;
• Per capita medical expenditures totaled $13,243 for people with diabetes, versus $2,560 for people without diabetes; and
• If per capita medical expenditures for populations with and without diabetes are adjusted for differences in age, sex, and race/ethnicity, folks with diabetes had medical expenditures about 2.4 times higher than expenditures incurred by the same group in the absence of diabetes.

So how does this affect health insurance costs? As both medical costs and the number of those diagnoses with diabetes have increased, the direct medical costs of this disease have certainly passed $100 billion annually and may very well now be $150 billion. These costs are either paid for by private insurers and folded into health insurance premiums or absorbed by Medicare and Medicaid (and other federal programs) and passed on in the form of taxes. The bottom line is this: we all pay for this epidemic one way or another.

There is something that can be done. Clinical studies suggest that, for those diagnosed with diabetes, prevention activities, quality outpatient care, and greater patient self-management (e.g., taking medications appropriately, controlling blood sugar levels, and managing diet with regular exercise) may prevent or reduce the prevalence of complications, such as cardiovascular disease and lower extremity amputations, as well as the incidence of multiple hospitalizations—and ultimately lower healthcare costs. For those not yet diagnosed, the risk of developing Type 2 diabetes can be reduced through maintenance of a healthy weight, a proper diet and regular exercise.

Prevention and better basic treatment ought to be a priority for state and federal lawmakers, policymakers, insurers, and healthcare providers. The goal ought to be to minimize the incidence of diabetes, medical complications resulting from diabetes and the overall costs of the disease. This can be accomplished through encouraging better use of primary care physicians; increased monitoring of those diagnosed with diabetes and those found to be at risk for the disease; and undertaking increased intervention activities for more vulnerable populations with diabetes, particularly racial/ethnic minorities, patients with public insurance coverage, and patients living in low-income areas. The return for these relatively inexpensive initiatives will be well worth the investment.

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