The Growth of Diabetes

 

Diabetes is now the fifth deadliest disease in the United States, and its prevalence is continuing to increase. 1 Between 1990 and 1999, the disease grew by more than 40 percent, affecting 4.9 percent of the population in the beginning of the decade and 6.9 percent by the end. And future projections offer little encouragement. For those born in the year 2000, roughly 1 in 3 males and 2 in 5 females will suffer from diabetes in their lifetime. For minority groups, the outlook is particularly grim. Trends show that African Americans and Hispanics will continue to be disproportionately affected if the diabetes epidemic is not addressed head-on. 2,3,4

How serious is diabetes? Let’s put it in these terms: diabetes is somewhat predictable when it comes to its effect on both lifespan and quality of life. If you are a male, diagnosed with diabetes at age 40, your life, on average, will be shortened by 11 to 13 years. When you consider both numbers of years and quality of life during those years, the impact is greater. Males with diabetes lose 18 to 20 quality-adjusted life years. Females fare worse, losing 12 to 17 years of life and 21 to 24 quality-adjusted life years. 2

The financial impact of diabetes on our nation is also staggering. With a total cost of health care of $865 billion in 2002, diabetes accounted for about $132 billion of that. Direct medical expenditures totaled $92 billion, including $23 billion for diabetes care, $25 billion for chronic diabetes-related complications, and $44 billion for excess prevalence of general medical conditions. More than $40 billion worth of indirect costs were attributable to lost workdays, restricted activity days, mortality, and permanent disability due to diabetes. 1

As I mentioned, the burden of diabetes is greater for minority populations than the white population in the United States. Diabetes affects 10.8 percent of African Americans and 10.6 percent of Hispanics, compared with 6.2 percent of whites. 5 Approximately 2.7 million, or 11.4 percent, of African Americans aged 20 years or older have diabetes – a rate that is 60 percent higher than in whites. Thus, they experience higher rates of at least four serious complications of diabetes: cardiovascular disease, blindness, amputation, and kidney failure. For example, among people with diabetes, African Americans are twice as likely to suffer from lower-limb amputations and twice as likely to suffer from diabetes-related blindness. 3

Hispanics are in a similar situation. Two million, or 8.2 percent, of Hispanics aged 20 or older, are affected by diabetes -- a rate that is 50 percent higher than in whites. As for complication rates, 35 percent of Mexican Americans are plagued by eye complications, and, among people with diabetes, Mexican Americans are 5 times more likely to suffer from kidney failure. 4

Considering these risks that are associated with poor management of diabetes, it’s remarkable how many diabetics, in every population, neglect their condition. Eighteen percent of diabetics have poor control of their blood sugar. Thirty-seven percent have had no eye exam in the past year, and almost half have had no foot exam. 6

When we add all this together, it’s obvious that we have a large-scale health problem on our hands -- one in which women and minorities are particularly vulnerable. How can we ever begin to address such a massive challenge?

To start with, we need leadership from the medical community. And the scale of our response needs to match the scale of the problem. That's why a new effort by the California Academy of Family Physicians is particularly impressive. CAFP has launched an ambitious project called “New Directions in Diabetes Care” to help physicians optimize the care of patients with diabetes in office practice. According to the group’s president, Eric Ramos, M.D., “The over-arching strategy is directed at inducing organizational changes in physicians’ offices to better accommodate disease management systems and streamline patient care to lead to improved efficiency and greater provider and patient satisfaction.” 7

In partnership with Lumetra, the Medicare quality improvement organization for the State of California, and the UCSF Department of Family and Community Medicine and its Collaborative Research Network, two streams of work have been outlined. First, clinical education will be expanded through the use of traditional and electronic platforms, expanded treatment guidelines, outcome measures, patient education with a focus on self-management, public awareness and legislative linkages to issues such as school nutrition. 7

The second focus is on comprehensive practice redesign, including family member involvement in the health care team, disease registries, group office visits, open access scheduling, electronic health records, and leveraging technology to improve surveillance and outcomes. 7

The CAFP initiative illustrates that effectively addressing a complex disease such as diabetes requires a strategic plan that reforms daily care practices in the office, in the community, and in the home.

It will take measures such as this to get our country’s diabetes epidemic under control.

For Health Politics, I’m Mike Magee.

References

1.American Diabetes Association: Economic Costs of Diabetes in the U.S. in 2002. Diabetes Care. 2003;26:917-932.

2.Venkat Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk of diabetes mellitus in the United States. JAMA. 2003;290:1884-1890.

3.American Diabetes Association: Diabetes Statistics for African Americans. Available at: www.diabetes.org/diabetes-statistics/african-americans.jsp. Accessed March 14, 2005.

4.American Diabetes Association: Diabetes Statistics for Latinos. Available at: www.diabetes.org/diabetes-statistics/latinos.jsp. Accessed March 14, 2005.

5.Mokdad AH, Ford ES, Bowman BA, et al. Diabetes trends in the U.S.: 1990-1998. Diabetes Care. 2000;23:1278-1283.

6.Saddine JB, Engelfau MM, Beckles GL, et al. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002;136:565-74.

7.Personal Communication. California Academy of Family Physicians, 2005.