1 Overview

Suggested citation: Endocrine Society. Endocrine Facts and Figures: Diabetes. First Edition. 2015.

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Diabetes is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, resistance to insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.1,2

This chapter covers facts and epidemiology data of the most common types of diabetes and related conditions including prediabetes, diabetes mellitus types 1 and 2, monogenic diabetes, diabetes in pregnancy (including gestational diabetes), and complications of diabetes.

1.1         EPIDEMIOLOGY

According to the latest estimates from the Centers for Disease Control and Prevention (CDC), the prevalence of diabetes among all ages in 2012 was 29.1 million, or 9.3% of the United States (US) population. This included 21 million diagnosed and 8.1 million undiagnosed people. Among the adult population 20 years of age or older, 1.9 million were newly diagnosed with diabetes in the US in 2010.3 In addition, among all diagnosed and undiagnosed patients aged 20 years or older, 15.5 million were males and 13.4 million were females. 3 Tables 1 and 2 present data on the prevalence of diabetes in the US.

Table 1. Prevalence of prediabetes and diabetes in adults in the United States.
Condition Data Source Population Prevalence Reference
Diabetes * NHANES 1999-2010 Age 20+ years 9.9-10.9% Selvin et al. 20144
NHANES 2009-2012 Age 20-44 years 4.1% Centers for Disease Control and Prevention 20143
Age 45-64 years 16.2%
Age 65+ years 25.9%
Prediabetes NHANES 2009-2012 Age 20+ years 37% Centers for Disease Control and Prevention. 20143

Note: *, prevalence of diabetes includes all types of diabetes combined.

Table 2. Prevalence of diabetes in children and adolescents in the United States.
Condition Data Source Population Prevalence Reference
Type 1 Diabetes SEARCH for Diabetes in Youth 2001-2009 Age 0-19 years 0.193% Dabelea et al. 20141
Type 2 Diabetes SEARCH for Diabetes in Youth, 2001-2009 Age 10-19 years 0.046% Dabelea et al. 20141

Diabetes in pregnancy, either pre-existing or developing during gestation, involves risks for the mother and fetus, as well as increased medical expenses. Table 3 summarizes the prevalence of diabetes in pregnancy in the US, based on a retrospective claims analysis from the Truven Health MarketScan database.5 While this study analyzed a large population, no data specific to race/ethnicity was provided and only included individuals with insurance. Therefore, it is important to note that the prevalence of diabetes in pregnancy can vary based on an individual’s racial or ethnic background.

Table 3. Prevalence of diabetes in pregnancy in the United States.
Condition Data Source Population Prevalence
Diabetes in pregnancy Truven Health MarketScan database (2004-2011), retrospective claims analysis Pregnant females, age 18-45 years Gestational diabetes 6.29%
Gestational diabetes progressing to type 2 diabetes 0.23%
Pre-existing type 1 diabetes 0.13%
Pre-existing type 2 diabetes 1.21%

Source: Jovanovic et al. 20155

Monogenic diabetes results from one of several genetic aberrations and is sometimes termed as Maturity-Onset Diabetes of the Young (MODY). Despite this name, it can appear at any point in the life cycle. The estimated prevalence of monogenic diabetes is derived from studies completed in European registries and health systems; two such estimates are presented in Table 4.

Table 4. Estimated prevalence of monogenic diabetes in children.
Condition Data Source Population Prevalence Reference
Monogenic Diabetes Norwegian Childhood Diabetes Registry, 2002-2012 Age 0-14 years 3.1:100,000 Irgens et al. 20136
Molecular Genetics Laboratory at the Royal Devon and Exeter Hospital (United Kingdom), 1996-2009 Age 1+ years 10.8:100,000 Shields et al. 20107

Table 5 presents a summary of the prevalence of diabetes-related complications.

 Table 5. Prevalence of complications of diabetes in the United States.
Complication of diabetes Prevalence Reference
Diabetic neuropathy 21.2% (among diagnosed with diabetes) Cheng et al. 20068
21.5% (among undiagnosed) Koopman et al. 20069
Diabetic retinopathy 28.5% – 33.2% (diabetic retinopathy) Zhang et al. 201010; Wong et al. 200611
4.4% (vision-threatening diabetic retinopathy) Zhang et al. 201010
9.0% (macular edema) Wong et al. 200611
Diabetic nephropathy 34.5% (any diabetic kidney disease) de Boer et al. 2011 12
26.5% (diabetic nephropathy) Koopman et al. 20069
17.7% (prediabetes) – 39.6% (diagnosed diabetes) (chronic kidney disease) Plantinga et al. 201013
Acute myocardial infarction 0.46% Gregg et al. 201414
Stroke 0.53% Gregg et al. 201414
Lower-limb amputation 0.28% Gregg et al. 201414
End-stage renal disease 0.20% Gregg et al. 201414
Death from hyperglycemic crisis 0.015% Gregg et al. 201414

 

1.2         COST BURDEN OF DISEASE

The total cost burden of diabetes to the US healthcare system was estimated to be $245 billion in 2012. The American Diabetes Association estimates that the majority of annual spending related to diabetes is hospital inpatient costs (43% of total spending), followed by prescription medications (18%) (Table 6).15

Table 6. Healthcare spending attributable to diagnosed diabetes in the United States, 2012.
Category Sub-Category Estimated Annual Cost
Total costs Direct costs, i.e., hospital and emergency care, office visits, medications $176 billion
Indirect costs, i.e., absenteeism, reduced productivity $69 billion
Sex-based cost differences Females with diabetes $8,331 per capita
Males with diabetes $7,458 per capita

Source: American Diabetes Association. 201315

These costs represent a 41% increase from 2007, when the total cost was $174 billion. In 2007, the cost of undiagnosed diabetes was estimated to be an additional $18 billion.15 Given recent increasing trends in diabetes incidence, it has been estimated that health costs attributable to diabetes could rise to $512 billion in 2021.16

Average annual medical expenditures for people with diabetes are higher than for people without diabetes (Table 7-8).15-17 More than 10% of healthcare spending in the US is spent on diabetes and its complications. In most cases, the highest percentage of spending is for people 65 years and older.15

It is estimated that the greatest burden of cost is on government programs, which account for 62.4% of all diabetes-related healthcare spending.15 Private insurers account for 34.4%, while uninsured individuals account for 3.2% of diabetes-related healthcare costs. Uninsured patients with diabetes are far less likely to visit physicians’ offices or take prescription medication for their conditions, but have up to 55% more emergency department visits than those covered by private or government-based insurance programs.15

 Table 7. Comparison of annual total costs for adults with and without diabetes in the United States.
Data Source Population Annual Healthcare Spending Per Capita
United Healthcare, 2009 Adults with diagnosed diabetes $11,700
Adults without diabetes $4,400

Source: Vojta et al. 201216

 Table 8. Comparison of annual total costs for children and adolescents with and without diabetes in the United States.
Data Source Population Annual Healthcare Spending Per Capita
Commercial insurance claims data (MarketScan), 2007 Youth with diagnosed diabetes $9,061
Youth without diabetes $1,468

Source: Shrestha et al. 201117

Additional factors contribute to the overall economic burden of diabetes. For example, the estimated total cost of prediabetes increased from $27 billion in 2007 to $38 billion in 2011, and could rise to $93 billion by 2021.16 Dall et al. estimated that the annual cost per patient of prediabetes was $443.18 Furthermore, the estimated cost of undiagnosed diabetes (types 1 and 2) increased from $12 billion in 2007 to $16 billion in 2011, and could grow to as much as $38 billion by 2021.16 These trends are summarized in Figure 1 (total cost) and Figure 2 (cost per patient).

Figure 1. Total estimated cost of diabetes (in US Billion Dollars). Undiagnosed Diabetes (Types 1 and )Type 1 DiabetesType 2 Diabetes

 Source: Vojta et al. 201216

Figure 2. Cost of diabetes per patient per year. Cost of Diabetes per Patient per Year

Note: For gestational diabetes, costs associated to newborn’s first year of life add up to $209.
Source: Dall et al. 201018

Retrospective analysis of insurance claims data shows that mean medical costs are higher among pregnant females with some form of diabetes than females without diabetes (Table 9).

Table 9. Total medical cost for pregnant patients with diabetes compared to non-diabetes patients.
Diabetes Type Mean total medical cost (per patient)*
Type 1 diabetes $27,531
Type 2 diabetes $22,739
Gestational diabetes $17,778
Gestational diabetes progressing to type 2 diabetes $23,055
Non-diabetes $14,355
Note: *, data reported for pregnancies that did not end in miscarriages; total cost includes pharmacy, inpatient and outpatient costs, from estimated pregnancy start date to 3 months after delivery.
Source: Jovanovic et al. 20155

 

Microvascular complications of diabetes, including nephropathy, neuropathy, and retinopathy, not only impact a patient’s quality of life but also involve costly interventions. One-year treatment costs for these complications are summarized in Table 10.

 Table 10. Annual costs association with microvascular complications of diabetes in the United States.
Complication Type Population Annual Cost References
Diabetic nephropathy Patients with type 1 diabetes $1.9 billion Gordois et al. 200419
Patients with type 2 diabetes $15.0 billion
Diabetic neuropathy Patients with type 1 diabetes $0.3–1.0 billion Gordois et al. 200320
Patients with type 2 diabetes $4.3–12.7 billion
Diabetic retinopathy Patients with diabetes over age 40 years $0.5 billion Centers for Disease Control and Prevention. 201121

Macrovascular complications of diabetes, including heart disease and stroke, pose some of the greatest cost burdens to the US healthcare system. Direct medical costs of these complications among patients with type 2 diabetes (in 2012 US dollars) are summarized in Table 11.

Table 11. Event-year* direct medical costs of macrovascular complications of diabetes.
Population Complication Type Annual Cost
Patients with type 2 diabetes Myocardial infarction $56,445
Ischemic stroke $42,119
Congestive heart failure $23,758
Ischemic heart disease $21,406
Transient ischemic heart attack $7,388
Note: *, event-year costs include resource use during initial inpatient/outpatient management, followed by subsequent care provided in the first year.

Source: Ward et al. 201422

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