Diabetes: A National Plan for Action. Introduction


Diabetes is approaching epidemic proportions in the United States. More than 18 million Americans today have diabetes. Approximately 41 million Americans have pre-diabetes,8 which means they are at high risk for developing type 2 diabetes.9 For people with diabetes, blood glucose (sugar) levels are elevated either because the body cannot make adequate amounts of the hormone insulin and/or its cells do not respond to insulin.10

Over the past half century, there has been a four- to eight-fold increase in the prevalence of diagnosed cases of diabetes in the U.S.11 In 2002, the prevalence of diagnosed diabetes among people aged 20 years or older was 8.7 percent and among 60 years or older was 18.3 percent.12 From 1997 through 2002, the number of new cases of diagnosed diabetes per year increased from 878,000 to 1,291,000 (a 47 percent increase).13 Projections of diabetes for future years are not encouraging (Figure 1). A 165 percent increase in the number of persons with diabetes in the U.S. is projected through 2050, with a rise from 11 million to 29 million diagnosed persons of all ages.14 Without preventive action, one in every three children born in the year 2000 will develop diabetes in their lifetime.15

In addition, minority populations are disproportionately affected by diabetes (Figure 2). On average Blacks, Hispanics, and American Indians and Alaska Natives are more likely (1.6 to 2.3 times as likely) to have diabetes than non-Hispanic Whites.16 Rates of diabetes-related deaths are higher among Blacks, American Indians, and Hispanics than for Whites,17 and diabetes is the 5th leading cause of death for Asian and Pacific Islanders.18 Certain minority groups also have much higher rates of diabetes-related complications, in some cases as much as 50 percent more than the diabetes population. For example, Blacks are more likely to have serious complications from diabetes, such as end-stage renal disease and lower extremity amputations.19

Costs of diabetes are high in both human and economic terms. While estimating the national costs for diabetes over time is difficult because of changes in the U.S. population and changes in the cost of health care services, evidence suggests that these costs are high and rising. The American Diabetes Association (ADA) estimated the national cost of diabetes for 2002 to be approximately $132 billion: $92 billion for direct medical expenditures and $40 billion for indirect costs, such as lost work days, restricted activity days, and mortality and permanent disability due to diabetes.20 Research from the Centers for Disease Control and Prevention (CDC) indicates that people with diabetes miss 8.3 days per year from work, compared to 1.7 days for people without diabetes.21 In the same ADA study, it is projected that the annual costs of diabetes (in 2002 dollars) could rise to $156 billion by 2010 and to $192 billion in 2020. By 2020, direct medical costs are estimated to increase to $138 billion and indirect costs from lost productivity could increase to $54 billion.22

Figure 1. Prevalence of Diagnosed and Projected Diagnosed Diabetes Cases in the United States, 1960-2050


SOURCE: Data for 1960–1998 from the National Health Interview Survey, National Center for Health Statistics (NCHS). Centers for Disease Control and Prevention (CDC) projected data for 2000–2050 from the Behavioral Risk Factor Surveillance System, Division of Diabetes Translation, CDC. (Note: The “Diagnosed cases” arrow refers to the section of the figure that includes diagnosed cases of diabetes versus the section that includes projected cases. The line graph and not the line arrow indicate the number of diagnosed cases.)


Figure 2. Age-Adjusted Total Prevalence of Diabetes in People Aged 20 Years or Older, by Race/Ethnicity: United States, 2002


SOURCE: 1999-2001 National Health Interview Survey and 1999-2000 National Health and Nutrition Examination Survey estimates projected to year 2002. 2002 outpatient database of the Indian. (Note: Whites refers to non-Hispanic Whites, and Blacks refers to non-Hispanic Blacks).

*AI/AN who receive care from the IHS.

8 Pre-diabetes is a condition defined by impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) or both.

9 CDC, op.cit.

10 ibid.

11 Centers for Disease Control and Prevention (CDC). Diabetes Surveillance System. Atlanta, GA, U.S. Department of Health and Human Services. Available at: http:www.cdc.gov/diabetes/statistics/index.htm; and Kenny SJ, Aubert RE, Geiss LS. Prevalence and incidence of non-insulin-dependent diabetes, in Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennette Ph (eds). (1995). Diabetes in America, 2nd ed. Bethesda, MD: National Institutes of Health.

12 Centers for Disease Control and Prevention (CDC). Diabetes Surveillance System. Atlanta, GA, U.S. Department of Health and Human Services. Available at: http:www.cdc.gov/diabetes/statistics/index.htm.

13 Centers for Disease Control and Prevention (CDC). Diabetes Surveillance System. Incidence of diabetes. Available at: http://www.cdc.gov/diabetes/statistics/incidence/fig1.htm. Accessed September 15, 2004.

14 Boyle JP, Honeycutt AA, Narayan KM, Hoerger TJ, Geiss LS, Chen H, Thompson TJ. (2001). Projection of diabetes burden through 2050: Impact of changing demography and disease prevalence in the U.S. Diabetes Care, 24(11), 1936-1940.

15 Narayan, op.cit.

16 Centers for Disease Control and Prevention (CDC). (2003). National diabetes fact sheet: General information and national estimates on diabetes in the United States. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2003.pdf.

17 ibid.

18 National Center for Health Statistics. (2003). 15 Leading causes of death for Asian and Pacific Islanders, 2001 Chart, Health, United States, 2003. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available at http://www.omhrc.gov/healthgap/datastats_aapi1.pdf.

19 World Health Organization. Global strategy on diet, physical activity and health. Available at: http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_R17-en.pdf. Accessed May 28, 2004; Centers for Disease Control and Prevention (CDC). (2003). Diabetes surveillance, 2003. [Statistics. 2003 surveillance report]. Atlanta: National Center for Chronic Disease and Prevention and Health Promotion, Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/diabetes/statistics/esrd/Fig5.htm; Agency for Healthcare Research and Quality (AHRQ). (2001). Diabetes disparities among racial and ethnic minorities. (AHRQ Pub. NO. 02-P007). Rockville, MD: AHRQ. Available at http://www.ahrq.gov/research/diabdisp.htm; and Gornic, ME, Eggers P.W, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, Vladeck BC. (1996). Effects of race and income on mortality and use of services among Medicare beneficiaries. New England Journal of Medicine, 335(11), 791-799.

20 American Diabetes Association (ADA). Direct and indirect costs of Diabetes in the United States. (2003). Available at: http://www.diabetes.org/diabetes-statistics/cost-of-diabetes-in-us.jsp. Accessed September 15, 2004; and ADA, op.cit., Economic costs of diabetes.

21 Centers for Disease Control and Prevention (CDC). Fact sheet,Diabetesatwork.org. Available at:
http://www.cdc.gov/diabetes/pubs/factsheets/atwork.htm. 2004.

22 ADA, op.cit., Economic costs of diabetes.


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