Diabetes Complications Still Common, Costly

Abstract

Miriam E. Tucker is a senior writer with Elsevier Global Medical News. The cost of diabetes complications in the United States topped $22 billion in 2006, according to a new report released at the annual meeting of the American Association of Clinical Endocrinologists. The report, titled State of Diabetes Complications in America, is part of an educational campaign sponsored by AACE in collaboration with a “diabetes complications consortium” comprising the Amputee Coalition of America, Mended Hearts (a nationwide patient support group affiliated with the American Heart Association), the National Federation of the Blind, and the National Kidney Foundation. The project is funded by GlaxoSmithKline. “There is a rather linear progression between how poorly controlled the diabetes is and how long it's poorly controlled, and whether you [develop] complications. So, the earlier you intervene and the more aggressively you intervene, the lower your risk for developing complications. We have known this for some time. What's remarkable about this report is that despite knowing this and despite having the tools to control blood glucose, we are still getting this high burden of complications,” Dr. Daniel Einhorn, secretary of AACE's board of directors, said at the AACE annual meeting. Data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) suggest dramatic differences in both macrovascular and microvascular disease between people with diagnosed type 2 diabetes and those without. Heart attack, for example, occurs in 9.8% of diabetic patients, compared with 1.8% of those with normal blood glucose levels; coronary heart disease in 9.1% vs. 2.1%; and stroke in 6.6% vs. 1.8%. As expected, microvascular complications affect people with diabetes even more disproportionately: 27.8% vs. 6.1% for chronic kidney disease and 22.9% vs. 10% for foot problems (including amputations, foot lesions, and numbness). Retinopathy was assessed among only NHANES participants who reported a diagnosis of diabetes, with the question “Have you been told diabetes has affected your eyes/had retinopathy?” The proportion responding affirmatively was 18.9%. Annual direct health care costs were assessed from the 2000, 2002, and 2004 Medical Expenditure Panel Survey. The total per capita cost of diabetes plus its complications (adjusted for inflation to reflect 2006 dollar amounts) was $9,797, of which $1,566 was out of pocket. In contrast, the total cost for people with diabetes but experiencing the same rate of complications as those without diabetes totaled $8,039, while the cost for people without diabetes (and with average complication rates) was $2,848. Total annual direct expenditures were $22.9 billion for diabetes complications alone and $57.1 billion for diabetes plus its complications. Among the complications, the most expensive per patient was heart attack, at $14,150, followed by chronic kidney disease ($9,002), congestive heart failure ($7,932), and stroke ($7,806). Among the microvascular complications, the total per-patient expenditure for foot problems was $4,687 and for eye damage (including retinopathy, cataracts, glaucoma, and blindness), $1,785. The diabetes complications consortium was formed “to provide helpful information to people with type 2 diabetes about how to reduce the risk of the health complications associated with the disease, as well as support and encouragement to people who have experienced these serious health problems.” The group's Web site is www.stateofdiabetes.com.