Cost-Effectiveness of Diabetes Interventions
If current trends continue, 1 in 3 Americans will develop diabetes sometime in their lifetime.1 Diabetes is a disease caused by too much sugar in the blood. When diabetes is not managed, it can damage vital organs. Most people who have diabetes have a shorter life expectancy than people without the disease.
Diabetes in the United States
- More than 34 million people of all ages (about 1 in 10) have diabetes, and 88 million adults (1 in 3) have prediabetes.2
- Diabetes complications are increasing for young adults aged 18 to 44 and middle-aged adults aged 45 to 64.3
- Diabetes is more common among Asian, non-Hispanic Black, and Hispanic people than non-Hispanic White people.
- Nearly 1 in 5 adolescents aged 12 to 18 years and 1 in 4 young adults aged 19 to 34 have prediabetes.4
Strategies That Work
CDC is working to help millions of Americans reduce their risk of type 2 diabetes and prevent or delay serious diabetes complications, which will save lives and money.
Preventing Type 2 Diabetes
To help prevent or delay type 2 diabetes, CDC’s National Diabetes Prevention Program (National DPP) delivers an affordable, evidence-based lifestyle change program. Studies show that lifestyle change programs can reduce the risk of type 2 diabetes by more than 50% for people at high risk. CDC and its partners are working to make the lifestyle change program available to more Americans. More than 525,000 adults have participated as of April 2021.
To make more people aware of their risk of prediabetes, CDC partnered with the American Diabetes Association, American Medical Association, and Ad Council to launch the first national prediabetes awareness campaign.
The Benefits of Using Proven Strategies
Many effective diabetes prevention and management strategies are a good value in terms of cost per quality-adjusted life year (QALY) gained. Public health interventions that cost less than $50,000 per QALY are widely accepted as cost-effective. For example:
- Intensive lifestyle modification to prevent type 2 diabetes among people at high risk costs $12,500‡(c) per QALY compared with self-monitoring once a day.6
- Self-monitoring of blood sugar levels three times a day by people with type 2 diabetes on insulin costs $3,700‡(c) per QALY compared with self-monitoring once a day.6
Screening to detect complications early in people with diabetes is also a good value and can prevent serious disabilities. For example:
- Screening for eye complications every 1 to 2 years costs $8,763‡(c) per QALY compared with no screening.6
- Annual screening for chronic kidney disease costs $21,000‡(a) per QALY compared with no screening.7
The campaign includes a 1-minute online risk test and links people to organizations across the country that deliver the National DPP lifestyle change program. More than 3.5 million people now know their prediabetes risk as a result.
Preventing Diabetes Complications
To prevent complications in people living with diabetes, CDC and its partners are working to expand access to and participation in diabetes self-management education and support (DSMES) services.
DSMES helps people with diabetes effectively manage their blood sugar, blood pressure, and cholesterol and get preventive care. For example:
- Effective blood sugar management can reduce the risk of eye disease, kidney disease, and nerve disease by 40%.9
- Blood pressure management can reduce the risk of heart disease and stroke by 33% to 50%.10 Improved cholesterol levels can reduce cardiovascular complications by 20% to 50%.11
- Regular eye exams and timely treatment could prevent up to 90% of diabetes-related blindness.12
- Health care services that include regular foot exams and patient education could prevent up to 85% of diabetes-related amputations.13
- Detecting and treating early diabetic kidney disease by using kidney protective medicines that lower blood pressure can reduce decline in kidney function by 33% to 37%.14
DSMES services reach almost 1 million people with diabetes each year.
total annual cost of diabetes15
The High Cost of Diabetes
Diabetes is the most expensive chronic condition in our nation.15,16
- $1 out of every $4 in US health care costs is spent on caring for people with diabetes.15
- $237 billion‡(c) is spent each year on direct medical costs and another $90 billion‡(c) on reduced productivity.15
- The total economic cost of diabetes rose 60% from 2007 to 2017.15
- 61% of diabetes costs are for people 65 years or older, which is mainly paid by Medicare.15
- 48% to 64% of lifetime medical costs for a person with diabetes are for complications related to diabetes, such as heart disease and stroke.17
‡ Costs were measured in a2006 US dollars, b2015 US dollars, and c2017 US dollars. Older cost estimates are likely to be underestimates.
- Boyle JP, Thompson TJ, Gregg EW, et al. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.
- Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2020.
- Gregg EW, Hora I, Benoit SR. Resurgence in diabetes-related complications. 2019;321:1867–1868.
- Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of prediabetes among adolescents and young adults in the United States, 2005–2016 [published online ahead of print December 2, 2019]. JAMA Peds.
- Zhou X, Siegel KR, Ng BP, et al. Cost-effectiveness of Diabetes Prevention Interventions Targeting High-risk Individuals and Whole Populations: A Systematic Review. Diabetes Care. 2020;43: 1593-1616.
- Siegel KR, Ali MK, Zhou X, et al. Cost-effectiveness of Interventions to Manage Diabetes: Has the Evidence Changed Since 2008?. Diabetes Care. 2020;43: 1557-1592.
- Hoerger TJ, Wittenborn JS, Segel JE, et al. A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening. Am J Kidney Dis. 2010;55:463–473.
- Institute for Clinical and Economic Review. Diabetes Prevention Programs: Effectiveness and Value. Final Evidence Report and Meeting Summary. Boston, MA: Institute for Clinical and Economic Review; 2016.
- Centers for Disease Control and Prevention. Diabetes: Stay Healthy website. https://www.cdc.gov/diabetes/managing/health.html. Accessed December 13, 2019.
- National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Bethesda, MD: National Heart, Lung, and Blood Institute; 2003.
- Daniel MJ. Lipid management in patients with type 2 diabetes. Am Health Drug Benefits. 2011;4:312–322.
- Murchison AP, Hark L, Pizzi LT, et al. Non-adherence to eye care in people with diabetes. BMJ Open Diabetes Res Care. 2017;5(1):e000333.
- Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult US population. Diabetes Care. 2019;42(1):50–54.
- Lewis EJ, Hunsicker LG, Clarke WR, et al; Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851–860.
- American Diabetes Association. Economic costs of diabetes in the US in 2017. Diabetes Care. 2018;41:917–928.
- Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996–2013. JAMA. 2016;316:2627–2646.
- Zhuo X, Zhang P, Hoerger TJ. Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. Am J Prev Med. 2013;45(3):253–261.