30 November 2009

Diabetes cases to double in 25 years

The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.


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 R831 billion ($113 billion) in 2009 to R2,500 billion ($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.

Precise forecasts

"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.

"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 Diabetes Care.

Cost of chronic disease

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% in the next decade and then declining slightly to about 27% 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."

The study

In making their estimates, the researchers used data on people 24 to 85 years old who took part in the US Centres 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 Centre 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 counselling 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. - (Jennifer Thomas/HealthDay News)


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