Medical Device Dailyer

Media reports have alerted many Americans to the crisis of obesity in America, particularly in children, with the frequent resulting health complications, such as Type 2 diabetes.

Now, a new report, titled "State of Diabetes Complications in America," paints a broad picture of the financial toll, as well as the clinical impact, of Type 2 diabetes, the more severe form of the disease.

Results from the report were released at the American Association of Clinical Endocrinologists' (AACE; Jacksonville, Florida) 16th Annual Meeting and Clinical Congress ongoing in Seattle.

The report looks at the prevalence and cost of the complications of Type 2 diabetes, made worse by the co-presence of other diseases among about 58% of those with Type 2 diabetes, the combination creating a massive financial drain on U.S. health spending.

In 2006, the nation spent an estimated $22.9 billion on direct medical costs related to diabetes complications, according to the report, which estimates costs as adjusted for inflation to reflect 2006 costs.

The report says that the estimated annual healthcare costs for a person with Type 2 diabetes and its complications are about three times higher than that of the average American without diagnosed diabetes.

Such complications — heart disease, stroke, eye damage, chronic kidney disease and foot problems, frequently leading to amputations — costs a person with Type 2 diabetes almost $10,000 each year. And people with diabetes complications pay nearly $1,600 out of their own pockets for costs not reimbursed by insurance, such as co-payments and deductibles.

That amount is significant, considering that according to the National Health Interview Survey, an estimated 40% of adults with diabetes reported an annual family income of less than $35,000 in 2005, indicating the significant financial consequences for some families.

The report was developed as a follow-up to a 2005 AACE study showing that two out of three Americans with Type 2 diabetes had elevated blood sugar levels, which can lead to diabetes complications.

And the report shows that an estimated 33.3% with the disease has one other serious health problem; about 10% with the disease have two other serious health problems; 6.7% with the disease has three other serious health problems; 7.6% has four or more other serious health problems — adding these, leading to the total of two out of three with co-presence of other disease.

"The report makes it clear that we have a major national issue when it comes to diabetes management, and that urgent action is needed," said Daniel Einhorn, MD, secretary of the AACE board.

The report synthesizes data from two large national studies examining the issue of diabetes-related complications in the U.S. Data on the prevalence of diabetes-related complications were derived from the National Health and Nutrition Examination Survey and combined with economic data from the Medical Expenditure Panel Survey.

The report estimates that in people with diabetes, there are specific health problems that are more prevalent than in people with normal blood sugar levels:

  • Congestive heart failure occurs in 7.9% of people with diagnosed diabetes vs. 1.1% of those without.
  • Heart attack occurs in 9.8% of people with diabetes vs. 1.8% without diabetes.
  • Coronary heart disease occurs in 9.1% of people with diabetes vs. 2.1% of those without.
  • Stroke occurs in 6.6% of people with diabetes vs. 1.8% of those without.

In terms of microvascular complications, which relate to small blood vessels, the prevalence is as follows:

  • Chronic kidney disease occurs in 27.8% of people with diabetes vs. 6.1% of those without.
  • Foot problems such as foot/toe amputation, foot lesions and numbness in the feet occur in 22.8% of people with diabetes vs. 10% of those without.

While type 2 diabetes is closely tied to the development of these complications, it is possible that some people may have developed these health problems independent of their diabetes, due to family history or other underlying medical conditions.

"Beyond the impact on quality-of-life, health complications from Type 2 diabetes also contribute to substantial national and individual healthcare costs," said Willard Manning, PhD, professor in the Harris School of Public Policy Studies at the University of Chicago. "My hope is that the report will call attention to the issue of diabetes-related complications and bring about change in the way we manage Type 2 diabetes to help reduce both the physical and financial burdens."

Regarding annual healthcare costs for people with Type 2 diabetes, heart attack is the most costly complication, at $14,150 per person, followed by chronic kidney disease ($9,002); congestive heart failure ($7,932); stroke ($7,806); coronary heart disease ($6,062); foot problems ($4,687); and eye damage ($1,785).*

"As great as these financial burdens are, this is a conservative estimate, as it only includes direct medical costs," said Manning. "Costs attributed to lost employment or productivity, premature death and disability have not been included, and if we factor in those costs, the overall burden would be far greater."

The report was presented by AACE in partnership with the members of a diabetes complications consortium: the Amputee Coalition of America (Knoxville, Tennessee); Mended Hearts (Dallas), a support group; the National Federation of the Blind (Baltimore); and the National Kidney Foundation (New York); and supported by pharma giant GlaxoSmithKline (London).