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Health Topics – Diabetes
Economic Burden
The total estimated cost of diagnosed diabetes in 2017 was 327 billion, including 237 billion in direct medical costs and 90 billion in reduced productivity. Average medical expenses among people with diagnosed diabetes were 2.3 times higher than among people without the disease.
Overview
More than 34 million Americans are currently living with diabetes, and one out of five are not aware of their diagnosis. Diabetes was the seventh leading cause of death in the United States in 2017. The disease is the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness. There are three main types of diabetes: type 1, type 2, and gestational diabetes (diabetes while pregnant). Type 1 diabetes is caused by the body not making enough insulin, and there is no known way to prevent it. Approximately 5-10% of the people who have diabetes have type 1. Type 2 diabetes is caused by the body’s inability to use insulin properly, and it can be prevented through healthy eating, physical activity, and weight management. About 90-95% of people with diabetes have type 2. A disease once seen almost exclusively in adults over age 45, type 2 diabetes is becoming increasingly common in adolescents. Gestational diabetes develops in pregnant women who have never had diabetes. Gestational diabetes usually goes away after the baby is born but does increase the mother and child’s risk for type 2 diabetes later in life.
Prediabetes is a serious condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. In 2018, 88 million American adults 18 years of age and older (1 in 3) had prediabetes, and only 15.3% were aware of it. Additionally, about 1 in 5 adolescents aged 12–18 years have prediabetes.
Risk Factors
Risk factors for type 1 diabetes include:
Family history: Having a parent, brother, or sister with type 1 diabetes
Age: More likely to develop when you’re a child, teen, or young adult.
Have Prediabetes
Being overweight or having obesity
Being 45 years or older
Having a family history of type 2 diabetes
Being physically active less than three times a week
Ever having gestational diabetes
The (National DPP) helps people who are at risk for type 2 diabetes prevent or delay the disease. Led by a trained coach, participants learn to make healthy lifestyle changes that can cut their risk by as much as 58% and 71% for people over 60 years old. Insurers and healthcare providers may help increase participation in the National DPP lifestyle change program by including the program as a covered health benefit, and referring patients and plan members/beneficiaries at risk for type 2 diabetes. Based on strong evidence of the program’s success, the Centers for Medicare & Medicaid Services (CMS) certified the expansion of the National DPP lifestyle change program into Medicare in March 2016. The new Medicare Diabetes Prevention Program (MDPP) became the first preventive service model from the Center for Medicare & Medicaid Innovation to be eligible for Medicare coverage, and is currently under evaluation to determine whether the program will become a permanent Medicare covered benefit. As of August 2020, over 1,700 organizations had been recognized by CDC to deliver the lifestyle change program in all 50 states. More than 487,000 people at high risk of type 2 diabetes had participated. Participants whose data have been evaluated lost an average of 5.5% of their body weight.
Diabetes self-management education and support (DSMES) services provide patients with the information they need to manage their diabetes. DSMES may help to reduce healthcare costs associated with hospital admissions, readmissions, and complications while improving health care outcomes for participants. In 2018, CDC released a DSMES Toolkit to provide a comprehensive set of resources and tools to support the development, promotion, implementation, and sustainability of DSMES services.
DSMES can be especially helpful in preventing diabetes complications during times of instability and crisis. Added stress and disruptions to daily routines and self-care can leave those living with diabetes vulnerable to infections and other illnesses. DSMES can be provided in-person or through telehealth.
Featured Resources
6/18 Evidence Summary (Type 2 Diabetes Prevention)
CDC’s 6|18 initiative provides partners with rigorous evidence about high-burden health conditions and associated interventions having the greatest health and cost impact. This summary provides a look at type 2 diabetes prevention in the United States, evidence of the effectiveness of the National DPP lifestyle change program, and guidance for employers and insurers.
Diabetes State & Local Programs
CDC’s Division of Diabetes Translation funds state and local health departments to support programs and activities to identify people with prediabetes; prevent, manage or delay the onset of type 2 diabetes; prevent diabetes complications; and to improve health outcomes for people diagnosed with diabetes.
Partnership with National Organizations
CDC’s Division of Diabetes Translation funds national organizations to further build the National DPP infrastructure in currently underserved areas and increase the availability of the evidence-based lifestyle change program for all adults with prediabetes or at high risk for type 2 diabetes.
Featured Tools
United States Diabetes Surveillance System (USDSS)
This interactive Web application allows the user to view diabetes surveillance data and trends at national, state, and county levels. The data come from surveys and databases used by the USDSS to examine trends in diagnosed diabetes and diabetes-related complications.
The Diabetes State Burden Toolkit provides state-level estimates of diabetes burden, economic costs, and mortality. The Toolkit also includes data about complications due to diabetes, quality-adjusted life years lost, and costs related to medical care, absenteeism, and lost household productivity.
Diabetes Prevention Impact Toolkit
The Diabetes Prevention Impact Toolkit was developed to help employers, insurers, and state health departments project the health and economic effects of offering the National DPP lifestyle change program to populations at risk for developing type 2 diabetes.
Nutrition, Physical Activity and Obesity: Data, Trends and Maps
This CDC online tool allows users to search for and view state-specific indicators related to nutrition, physical activity, and obesity. Users can search on the basis of a specific location or an indicator.
The National DPP Coverage Toolkit is an online resource to support self-insured employers and Medicaid, Medicare Advantage, and commercial health plans that are considering covering or implementing the National DPP lifestyle change program. The Toolkit includes resources to determine the best program delivery options, review the evidence and make the business case for coverage, see a list of other payers offering coverage, and much more.
Vision and Eye Health Surveillance System
The Vision and Eye Health Surveillance System (VEHSS) provides data to help health professionals, researchers, policy makers, and patients understand the scope of vision loss, eye disorders, and eye care services in the United States. It was developed by CDC and NORC at the University of Chicago.
CDC used VEHSS data to create state profiles of the impact of vision impairment and comorbid conditions across the United States. The profiles provide state-level data from the Behavioral Risk Factor Surveillance System (BRFSS) and the American Community Survey, as well as county-level maps for each state that show the prevalence of self-reported severe vision impairment.
Health and Economic Cost of Chronic Diseases
Chronic diseases have significant health and economic costs in the United States. Preventing chronic diseases or managing symptoms when prevention is not possible, can reduce these costs.
The Virtual Healthy School provides examples of what a healthy school environment looks like and how to implement the Whole School, Whole Community, Whole Child model for creating a healthier school.