Abstract
BackgroundPeople with diabetes can suffer from diverse complications that seriously erode quality of life. Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years. Accurate projections of diabetes burden are essential to policymakers planning for future health care needs and costs.MethodsUsing data on prediabetes and diabetes prevalence in the United States, forecasted incidence, and current US Census projections of mortality and migration, the authors constructed a series of dynamic models employing systems of difference equations to project the future burden of diabetes among US adults. A three-state model partitions the US population into no diabetes, undiagnosed diabetes, and diagnosed diabetes. A four-state model divides the state of "no diabetes" into high-risk (prediabetes) and low-risk (normal glucose) states. A five-state model incorporates an intervention designed to prevent or delay diabetes in adults at high risk.ResultsThe authors project that annual diagnosed diabetes incidence (new cases) will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050. Assuming low incidence and relatively high diabetes mortality, total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the US adult population by 2050. However, if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050. A middle-ground scenario projects a prevalence of 25% to 28% by 2050. Intervention can reduce, but not eliminate, increases in diabetes prevalence.ConclusionsThese projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer. Effective strategies will need to be undertaken to moderate the impact of these factors on national diabetes burden. Our analysis suggests that widespread implementation of reasonably effective preventive interventions focused on high-risk subgroups of the population can considerably reduce, but not eliminate, future increases in diabetes prevalence.
Highlights
People with diabetes can suffer from diverse complications that seriously erode quality of life
Effective strategies will need to be undertaken to moderate the impact of these factors on national diabetes burden
Our analysis suggests that widespread implementation of reasonably effective preventive interventions focused on high-risk subgroups of the population can considerably reduce, but not eliminate, future increases in diabetes prevalence
Summary
People with diabetes can suffer from diverse complications that seriously erode quality of life. People with diabetes often develop diverse microvascular, macrovascular, and neuropathic complications that seriously erode quality of life. The high prevalence, high incidence, chronicity, and long-term implications for health and health care costs make diabetes a major concern for the United States and much of the developed. Several future projections of the prevalence, incidence, and total number of diabetes cases for the US and other countries have been carried out [5,6,7,8]. Previous estimates for the US are likely to be outdated because they relied on 1990 census projections These older census projections overestimate current mortality rates and do not account for the increasing size of the Hispanic and foreign-born US populations at higher risk for developing diabetes. Earlier estimates ignored the substantial variation in diabetes incidence occurring between the subpopulation with normal glucose levels and the subpopulation with prediabetes
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