Understanding the Economic Costs of Diabetes and Prediabetes and What We May Learn About Reducing the Health and Economic Burden of These Conditions.

Abstract

Over 30 million people suffered from diabetes in 2015, representing 9.4% of the entire U.S. population and 12.2% of all adults (1). One in four of these people did not know they had diabetes (1). Furthermore, in the same year, approximately 84.1 million U.S. adults—over a third of U.S. adults (33.9%)—were believed to have prediabetes, 90% of whom were also unaware of their condition (1). The high prevalence of gestational diabetes mellitus (GDM) (6.0%) among women who gave birth in 2016 further underscores the seriousness of this epidemic (2). The burden of diabetes is not uniformly shared, varying by age, education, income, location, race/ethnicity, and other social determinants of health (SDOH) (1–6). Greater burden is evident among adults with lower educational attainment and household income than among adults of higher socioeconomic status (1,3), disparities that have widened over time (3). In 2015, compared with non-Hispanic whites (7.4%), the age-adjusted prevalence of diagnosed diabetes was higher among American Indian and Alaska Native adults (15.1%), non-Hispanic black adults (12.7%), adults of Hispanic ethnicity (12.1%), and Asian adults (8.0%) (1). The prevalence of undiagnosed diabetes (4,5), prediabetes (7), and GDM (2,6) also varied by SDOH. Federal, state, and local governments—ultimately, taxpayers—bear the brunt of diabetes-related costs. For example, Medicare’s diabetes-related burden increased during recent years as the prevalence of diabetes increased (8). Updated, comprehensive information on the economic burden of diabetes-related conditions is critical for governments, employers, other health payers, and health care providers to assess opportunities for improving service delivery and, ultimately, health outcomes. Dall et al. (9) updated and expanded the American Diabetes …