Economic Burden Of Diabetes Research Articles

Economic Burden of Diabetes: A Review of Literature

Economic Burden of Diabetes: A Review of Literature

The epidemiological and economic burden of diabetes in Ghana: A scoping review to inform health technology assessment.

Diabetes remains one of the four major causes of morbidity and mortality globally among non-communicable diseases (NCDs. It is predicted to increase in sub-Saharan Africa by over 50% by 2045. The aim of this study is to identify, map and estimate the burden of diabetes in Ghana, which is essential for optimising NCD country policy and understanding existing knowledge gaps to guide future research in this area. We followed the Arksey and O'Malley framework for scoping reviews. We searched electronic databases including Medline, Embase, Web of Science, Scopus, Cochrane and African Index Medicus following a systematic search strategy. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews was followed when reporting the results. A total of 36 studies were found to fulfil the inclusion criteria. The reported prevalence of diabetes at national level in Ghana ranged between 2.80%- 3.95%. At the regional level, the Western region reported the highest prevalence of diabetes: 39.80%, followed by Ashanti region (25.20%) and Central region at 24.60%. The prevalence of diabetes was generally higher in women in comparison to men. Urban areas were found to have a higher prevalence of diabetes than rural areas. The mean annual financial cost of managing one diabetic case at the outpatient clinic was estimated at GHS 540.35 (2021 US $194.09). There was a paucity of evidence on the overall economic burden and the regional prevalence burden. Ghana is faced with a considerable burden of diabetes which varies by region and setting (urban/rural). There is an urgent need for effective and efficient interventions to prevent the anticipated elevation in burden of disease through the utilisation of existing evidence and proven priority-setting tools like Health Technology Assessment (HTA).

Type 2 Diabetes Mellitus in Tanzania. A Narrative Review of Epidemiology and Disease Trend.

The prevalence of type 2 diabetes is on a rapid rise in Tanzania, driven by lifestyle modifications, nutritional changes, and increased obesity rates. This article reviews the epidemiology, and disease trends of type 2 diabetes in Tanzania and explores the economic implications and challenges in care, including policy, education, and healthcare systems. The study employs a narrative literature review from research articles, local healthcare reports, surveys, and public health records. It evaluates the economic impacts, healthcare capabilities, and patient behaviors in managing type 2 diabetes in Tanzania. The economic burden of diabetes in Tanzania is increasing due to direct healthcare costs, lost productivity, and reduced quality of life, placing significant pressure on the already resourcelimited healthcare system. Treatment dropout rates are alarmingly high, and healthcare providers' knowledge of diabetes is insufficient. Insulin and metformin availability are critically low. Cultural norms and dietary habits pose substantial barriers to effective disease management. The growing prevalence of type 2 diabetes in Tanzania presents a significant public health crisis, necessitating comprehensive strategies for prevention, early detection, and effective disease management. Priorities should include enhancing healthcare infrastructure, increasing public investment, improving healthcare education, and tackling socio-cultural barriers to disease management.

Assessing and projecting the burden of diabetes mellitus in the European Union by 2030

Abstract Background Although the upward trend in diabetes mellitus (DM) is known in many countries, there are considerable uncertainties in the forecasts. This study provides valuable insights into the potential development of DM in the European Union (EU) member states through past trends and future projections. Methods European Health Interview Survey (EHIS) 2015 and 2019 microdata from 27 EU countries were used. Finite mix model (fmm) was applied to identify subgroups within the population and obtain probability of risk factors within each group. Time indicator as interaction was added to obtain the developing trend of heterogeneous effects with socioeconomic and lifestyle risk factors that were included in the model. Forecasting was used to project probability of risk factors within each group up to 2030. Results Data included 500,840 participants (274,016 from 2015 and 226,824 from 2019). Fmm and forecasting results showed DM prevalence was 7.4% in 2015 and 8.4% in 2019 and expected to increase to 11.15% in 2030. High- and low-risk subgroups were identified. Most risk factors and lifestyle categories increased in the high-risk group in comparison to the low-risk group between 2015 and 2019. However, within the high risk group, the probability of living rural areas has decreased 2.7% 2015 vs. 2019 and is expected to further decrease by 10.2% up to 2030. Additionally, within the high-risk group, the likelihood of living in towns and suburbs, having a tertiary education and eating fruit and vegetables 1-6 times a week have increased by (3%, 5%, 1.7%, 4.4%) compared to other categories for each risk factor and are expected to be higher in 2030 by (11.6%, 18.6%, 5%, 16.3%). Conclusions According to EHIS data, from 2015 to 2030, the number of people with diabetes in the EU will change and increase by 3.8 %. This increase will vary by subgroup.More data on risk factors are needed to obtain more accurate estimates. Key messages • The future health and economic burden of diabetes on society, health systems and the national economy is expected to increase in the EU. • Implementing effective prevention strategies on a large scale can reduce the future burden of diabetes.

Trends in economic burden of type 2 diabetes in China: Based on longitudinal claim data.

Diabetes is a major health issue in China that has a significant economic burden on society. Understanding the economic impact of diabetes can help policymakers make informed decisions about healthcare spending and priorities. This study aims to estimate the economic burden of patients with diabetes in an urban setting in China and to identify the impact of hospitalization and complications on health care costs for people with diabetes. The study was conducted in a sample city located in eastern China. All patients diagnosed with diabetes before January 2015 were identified from the official health management information system, and their social demographics and records of their health care uses and costs were extracted from the claim database from 2014 to 2019. Six groups of complications were identified according to ICD-10 codes. The diabetes-related direct medical cost (DM cost) was described for patients in stratified groups. A multiple linear regression model was applied to identify the effect of hospitalization and complications on the DM cost of diabetic patients. Our research included 44,994 patients with diabetes, the average annual DM costs for diabetic patients increased from 1,292.72 USD in 2014 to 2,092.87 USD in 2019. The costs of diabetes are closely related to hospitalizations and the type and number of complications. The average annual DM cost of patients who were hospitalized was 2.23 times that of those without hospitalization, and it rose as the number of complications increased. Cardiovascular complications and nephropathic complications were the complications that had the greatest impact on patients' DM costs, increasing by an average of 65 and 54%, respectively. The economic burden of diabetes in urban China has increased significantly. Hospitalization and the type and number of complications have significant impacts on the economic burden of patients with diabetes. Efforts should be made to prevent the development of long-term complications in the population with diabetes.

Cost of diabetes and its complications: results from a STEPS survey in Punjab, India

BackgroundDiabetes mellitus is an obtrusive universal health emergency in developed and developing countries, including India. With the exponential rise of epidemiological conditions, the costs of treating and managing diabetes are on an upsurge. This study aimed to estimate the cost of diabetes and determine the determinants of the total cost among diabetic patients.MethodsThis cross-sectional study was executed in the northern state of Punjab, India. It involves the multi-stage area sampling technique and data was collected through a self-structured questionnaire adapted following the “WHO STEPS Surveillance” manual. Mann–Whitney U and Kruskal–Wallis tests were performed to compare the cost differences in socio-demographic variables. Lastly, multiple linear regression was conducted to determine and evaluate the association of the dependent variable with numerous influential determinants.ResultsThe urban respondents' average direct and indirect costs are higher than rural respondents. Age manifests very eccentric results; the highest mean direct outpatient care expenditure of ₹52,104 was incurred by the respondents below 20 years of age. Gender, complications, income, history of diabetes and work status were statistically significant determinants of the total cost. Study reports a rapid increase in the median annual direct and indirect cost from ₹15,460 and ₹3572 in 1999 to ₹34,100 and ₹4200 in 2021.ConclusionsThe present study highlights that the economic jeopardy of diabetes can be managed by educating people about diabetes and its associated risk factors. The economic burden of diabetes could be restrained by formulating new health policies and promoting the use of generic medicines. The result of the study directs that expenditure on outpatient care is to be reimbursed under the ‘Ayushman Bharat-Sarbat Sehat Bima Yojana’.

IDF2022-0868 Changes in the prevalence and economic burden of diabetes in Singapore: results from repeated cross-sectional surveys

IDF2022-0868 Changes in the prevalence and economic burden of diabetes in Singapore: results from repeated cross-sectional surveys

Projected rapid growth in diabetes disease burden and economic burden in China: a spatio-temporal study from 2020 to 2030

This study projects the trend of disease burden and economic burden of diabetes in 33 Chinese provinces and nationally during 2020-2030 and investigates its spatial disparities. Time series prediction on the prevalence and disability-adjusted life-year (DALY) rates of diabetes was conducted using a Bayesian modelling approach in 2020-2030. The top-down method and the human capital method were used to predict the direct and indirect costs of diabetes for each Chinese province. Global and local spatial autocorrelation analyses were used to identify geographic clusters of low-or high-burden areas. Diabetes prevalence in Chinese adults aged 20-79 years was projected to increase from 8.2% to 9.7% during 2020-2030. During the same period, the total costs of diabetes would increase from $250.2 billion to $460.4 billion, corresponding to an annual growth rate of 6.32%. The total costs of diabetes as a percentage of GDP would increase from 1.58% to 1.69% in China during 2020-2030, suggesting a faster growth in the economic burden of diabetes than China's economic growth. Consistently, the per-capita economic burden of diabetes would increase from $231 to $414 in China during 2020-2030, with an annual growth rate of 6.02%. High disease and economic burden areas were aggregated in Northeast and/or North China. Our study projects a significant growth of disease and economic burden of diabetes in China during 2020-2030, with strong spatial aggregation in northern Chinese regions. The increase in the economic burden of diabetes will exceed that of GDP. National Natural Science Foundation of China, Outstanding Young Scholars Funding.

Economic Burden of Diabetes and Hypertension: A Study of Direct and Indirect Cost of Treatment in Southeast Nigeria.

The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle-income countries such as Nigeria. The increasing burden of these noncommunicable diseases has led to an increase in the overall cost of health care. This study aimed at determining the direct and indirect health care costs of diabetes mellitus and hypertension occurring both singly and in co-morbidity. The study was undertaken in the Enugu State University Teaching Hospital (a tertiary hospital) in Enugu State, Southeast Nigeria. Data were collected using a pre-tested questionnaire. Out of 817 patients interviewed, 37% had only diabetes mellitus, 35% had hypertension, and 28% had both diabetes mellitus and hypertension in co-morbidity. Direct costs of treating diabetes mellitus and hypertension in the month before the survey were $28.40 and $19.35, respectively, while the indirect costs of treatment in the month before the study were $7.36 and $5.51, respectively. Direct and indirect costs for diabetes mellitus and hypertension in co-morbidity were $37.00 and $4.62, respectively. A concentration index showed that diabetes mellitus and hypertension were more evident among the poor than the rich. The economic cost when compared with patients' income revealed that >25% of their income is spent monthly on health care.

Early Detection of Diabetic Peripheral Neuropathy by fMRI: An Evidence-Based Review.

With the significant rise in the prevalence of diabetes worldwide, diabetic peripheral neuropathy (DPN) remains the most common complication among type 1 and 2 diabetics. The adverse sequelae of DPN, which include neuropathic pain, diabetic foot ulcers and lower-limb amputations, significantly impact quality of life and are major contributors to the biopsychosocial and economic burden of diabetes at the individual, societal and health system levels. Because DPN is often diagnosed in the late stages of disease progression by electromyography (EMG), and neuropathic pain as a result of DPN is difficult to treat, the need for earlier detection is crucial to better ascertain and manage the condition. Among the various modalities available to aid in the early detection of DPN, functional magnetic resonance imaging (fMRI) has emerged as a practical tool in DPN imaging due to its noninvasive radiation-free nature and its ability to relate real-time functional changes reflecting the local oxygen consumption of regions of the CNS due to external stimuli. This review aims to summarize the current body of knowledge regarding the utility of fMRI in detecting DPN by observing central nervous system (CNS) activity changes among individuals with DPN when compared to controls. The evidence to date points toward a tendency for increased activity in various central neuroanatomical structures that can be detected by fMRI and positively correlates with diabetic neuropathic pain.

Direct and Indirect Costs of Diabetes in Brazil in 2016.

Background:The global economic burden of Diabetes mellitus (DM) is expected to reach US$ 745 billion in 2030. The growing prevalence of the disease, mainly type 2 diabetes, is the result of population aging, nutritional transition, which include growing rates of obesity and consumption of foods high in sugar and fat. Brazil is the fourth country in the number of patients with diabetes globally and follows the global trends, with a continuous increase in prevalence.Objectives:To estimate the economic burden of DM in Brazil, including all direct and indirect costs.Methods:We used a cost-of-illness approach to calculate the total economic burden of DM. We used official healthcare-related statistics referring to 2016.Findings:We estimated the Brazilian economic burden to reach US$ 2.15 billion in 2016, of which 70.6% are indirect costs related to premature deaths, absenteeism, and early retirement. We estimate that if the rate of growth of diabetes prevalence remains in Brazil, direct and indirect costs of diabetes will more than double by 2030 (an increase of 133.4% or 6.2% per year).Conclusion:Our results are in accordance with the literature that shows that indirect costs are more relevant in low- and middle-income countries due to poorer access to health care, which result in higher mortality rates from non-communicable diseases. However, due to the potentially underestimated prevalence of diabetes in Brazil and the lack of access to nationwide private healthcare costs, we estimate costs of diabetes in Brazil to be higher than the conservative results we found. The onset of the COVID-19 pandemic is likely to result in even greater costs than what we estimated.

Costs of Diabetes Mellitus and Its Complications in Bosnia and Herzegovina

Background: The economic burden induced by all types of Diabetes mellitus (DM) and their complications has reached 1.8% of gross domestic product (GDP) globally. The economic burden of diabetes mellitus in Bosnia & Herzegovina (B and H) is still unknown. Objective: To investigate the economic burden of diabetes in Bosnia and Herzegovina, including the costs of diagnosing and treating diabetes and its complications. Methods: The study was designed as a top-down cost of illness study, based on prevalence, analyzing both direct and indirect costs of DM and complications caused by DM. All types of DM were taken into account, and estimates were based on total B and H population. Costs of services per patient were calculated by multiplication of share of treated population, service utilization data and unit costs. Results: Annual economic burden associated with DM in B and H is around 189 million euro (739 euro per patient), which makes 1.11% of gross domestic product (GDP) of B and H in 2020 (16,993,101,523 euro, according to the World Bank data). The largest part of this burden was created by DM medication and costs of managing complications (heart failure and stable angina being major cost drivers among the complications), followed by laboratory tests and physician visits. Conclusion: Total costs of DM per patient in B and H are within the range of costs in other Central-Eastern European (CEE) countries, reflecting significant economic burden, but also determination of healthcare payers in B and H to provide optimal management of DM in congruence with contemporary clinical guidelines.

Expert Opinion About the Pharmacoeconomic Edge of Low-Cost Dapagliflozin in Type 2 Diabetes Mellitus in Indian Clinical Settings.

BackgroundThis study aimed to understand the attitudes, beliefs, and concerns of physicians across India regarding the economic burden of diabetes and subsequently the cost-effectiveness of low-cost dapagliflozin for the management of patients with uncontrolled type 2 diabetes mellitus (T2DM) on background metformin therapy in Indian clinical settings.MethodA cross-sectional questionnaire survey was conducted among physicians treating people with T2DM with or without complications. The questions covered the general aspects of affordability and adherence to diabetes medications as well as specific details of low-cost dapagliflozin and its cost-effectiveness.ResultsIn total, 844 physicians provided a response to the survey questionnaire. The physicians who participated in the study included diabetologists, endocrinologists, cardiologists, consulting physicians, and family physicians. A majority of the physicians (53%) opined that only 10%-30% of their patients can afford the cost of newer antidiabetic medicines, while 25% of the physicians mentioned that <10% of their patients had issues related to affordability. Further, 39% of the physicians opined that 20%-40% of their patients discontinue the medicines due to high cost. Most of the physicians (95%) agreed that due to the low cost of dapagliflozin, it can be used for the primary prevention of heart failure in patients with T2DM in India. Similarly, 98% of the physicians agreed that it can be used for the treatment of heart failure in patients with or without T2DM in India. A majority of these physicians (93%) responded that switching from expensive sodium/glucose cotransporter-2 inhibitors (SGLT2i) to low-cost dapagliflozin is a long-term cost-effective management of T2DM. In total, 98% of the physicians agreed that low-cost dapagliflozin has the characteristics of an ideal SGLT2i because of its metabolic benefits, cardioprotection, nephroprotection, and potential cost-effectiveness.ConclusionThis survey-based study indicates that dapagliflozin is an effective and cost-saving therapy for patients with T2DM and complications. Low-cost dapagliflozin can revolutionize the treatment of T2DM in the Indian setting.

Abstract MP66: Higher Habitual Flavonoid Intakes Are Associated With A Lower Incidence Of Diabetes

Introduction: The promotion of evidence-based diets is an important s trategy to mitigate the global health and economic burden of diabetes. Higher flavonoid intakes are associated with a lower risk of obesity and diabetes. Less clear are associations of the flavonoid subclasses with diabetes, the mediating impact of body fat, and the identification of subpopulations that may receive the greatest benefit. Hypothesis: Higher flavonoid intakes will be associated with lower body fat at baseline and a lower risk of diabetes during follow-up. Methods: Incident diabetes was assessed in 54,787 participants of the Danish Diet, Cancer, and Health Study followed-up for 23 years. Dietary intake and objective measures of body fat were assessed at baseline; habitual flavonoid intake was calculated using the Phenol-Explorer database and body fat was objectively assessed using bioelectrical impedance. Incidence of diabetes was obtained using Danish National Patient and Prescription Registries. Cross-sectional associations between flavonoid intakes and body fat were assessed using multivariable-adjusted linear regression models. Non-linear associations between flavonoid intake and incident diabetes were examined using restricted cubic splines based on multivariable-adjusted Cox proportional hazards models. Results: Among 54,787 participants without diabetes at baseline (median [IQR] age of 56 [52 - 60] years; (47.3%) men), 6,700 individuals were diagnosed with diabetes. Participants in the highest total flavonoid intake quintile (median, 1,202 mg/d) had a 1.52 kg lower body fat (95% CI: -1.74, -1.30) and a 19% lower risk of diabetes [HR (95% CI): 0.81 (0.75, 0.87)] after multivariable adjustments and compared to participants in the lowest intake quintile (median, 174 mg/d). Body fat mediated 51.6% of the association between flavonoid intake and incident diabetes. Neither smoking status, BMI, nor sex appeared to modify the association between total flavonoid intake and incident diabetes. However, the difference (flavonoid intake quintile 5 - quintile 1) in the 20-year estimated absolute risk of diabetes was greatest for current smokers (males: 2.19%, females: 1.65%) and those with a BMI ≥30 kg/m 2 (males: 5.56%, females: 4.59%), likely owing to the higher prevalence of diabetes in these “at risk” subgroups. Moderate to high intakes of flavonols, flavanol monomers, flavanol oligo+polymers, and anthocyanins, and the individual compounds within these subclasses, were associated with a lower risk of diabetes. Conclusion: In this Danish prospective cohort study, we observed that higher flavonoid intakes were cross-sectionally associated with lower body fat, and longitudinally associated with a lower risk of diabetes. Our results suggest that promoting a diet abundant in flavonoid-rich foods may help to ameliorate diabetes risk, in part through a reduction in body fat.

Run for your life: can exercise be used to effectively target GLUT4 in diabetic cardiac disease?

The global incidence, associated mortality rates and economic burden of diabetes are now such that it is considered one of the most pressing worldwide public health challenges. Considerable research is now devoted to better understanding the mechanisms underlying the onset and progression of this disease, with an ultimate aim of improving the array of available preventive and therapeutic interventions. One area of particular unmet clinical need is the significantly elevated rate of cardiomyopathy in diabetic patients, which in part contributes to cardiovascular disease being the primary cause of premature death in this population. This review will first consider the role of metabolism and more specifically the insulin sensitive glucose transporter GLUT4 in diabetic cardiac disease, before addressing how we may use exercise to intervene in order to beneficially impact key functional clinical outcomes.

Leveraging Mechanical Forces to Target Insulin Injection-Induced Lipohypertrophy and Fibrosis.

As of 2017, more than 30 million Americans—nearly 10% of the population—have diabetes (1). More than 1.5 million new cases of diabetes were diagnosed in 2015 (1). The prevalence of both type 1 and type 2 diabetes is rapidly increasing, and by 2050, diabetes is expected to affect more than one in five adults in the United States (2–5). The economic burden of diabetes is enormous and growing; in 2017, it was estimated to be $327 billion, including $237 billion in direct medical costs (6), a nearly twofold increase from 2007 (3). The 1.25 million American adults living with type 1 diabetes comprise 5.6% of all U.S. adults with a diabetes diagnosis (7). Because these patients are unable to produce sufficient endogenous insulin, they are reliant on exogenous insulin injections for their entire lives. In addition to individuals with type 1 diabetes, roughly 30% of patients with type 2 diabetes also require insulin therapy, typically in the setting of A1C levels that are uncontrolled with oral hypoglycemic agents (8–11). Recently, exorbitant insulin prices have dominated news headlines across the United States. In just 5 years, from 2012 to 2017, the cost of insulin increased by 110% (6). Insulin costs totaled more than $14 billion in 2017, not including required supplies and equipment, which were responsible for an additional $5 billion in costs (6). Beyond the sizeable economic burden of insulin use, long-term insulin administration can also cause a host of problems for patients. In particular, repeated insulin injections and insulin pump use often result in complications and changes in the skin at injection or pump sites (Figure 1) (12). The two most common injection site complications are: 1. Fibrosis, the accumulation of stiff, dense scar tissue at the injection site (Figure 1 A , middle …

Recent trends for the management of diabetes for older adults in the context of universal coverage and COVID-19: evidence from Mexico.

BackgroundTo identify trends in the epidemiological and economic burden of diabetes in the elderly.MethodsUsing the Box–Jenkins method to estimate expected cases for the period 2020–2022, costs were determined with the instrumentation technique. The population base was 4 032 189 older adults diagnosed with diabetes in 2019.ResultsRegarding the epidemiological burden, there is an increase of 11–15% (p<0.001). Comparing the economic burden for 2020 vs 2022, the increase is estimated as 29% (p<0.05).ConclusionIn the framework of the coronavirus disease 2019 pandemic, the increase in diabetes cases and costs in older adults substantially complicates the scope of universal coverage for patients with diabetes.

Physical activity is associated with lower health care costs among Taiwanese individuals with diabetes mellitus.

The economic burden of diabetes has increased over time with disease severity. Previous publications investigating the effects of physical activity (PA) on medical costs have made use of small sample sizes. We assessed the relationship between PA and 1-year medical expenditure among Taiwanese patients with type-2 diabetes mellitus (T2DM).Data were recruited from three governmental databases, including the 2012 adult preventive health service database. Participants were grouped as inactive (no exercise), insufficiently active (exercise < 150 minutes/week), and sufficiently active (exercise >150 minutes/week) individuals. Patients were stratified according to age and Charlson score. Multivariate linear regression models were used to determine β-coefficients and their P values.Overall, 218,960 individuals were identified with diabetes. The prevalence of the disease was 13.1% among sufficiently active, 35% among insufficiently active, and 51.9% among physically inactive adults. In general, patients who had exercise >150 minutes/week had lower health care spending (i.e., US$ 755.83) followed by those who had less than 150 minutes/week (US$ 880.08) when compared with inactive patients (P < .0001). Moreover, health care costs derived from outpatient or inpatient care were lower for sufficiently active than inactive participants (P < .0001).Compared with being sedentary, PA was associated with lower health care costs of Taiwanese adults with diabetes mellitus.

Cardiorespiratory Fitness and Health Care Costs in Diabetes: The Veterans Exercise Testing Study

This study aimed to determine the association between cardiorespiratory fitness and healthcare expenditures among individuals with and without diabetes. Health care costs were quantified among 3924 consecutive men (mean age 58 ± 11 years) referred for a maximal exercise test, and compared according to presence (n = 2457) and absence (n = 1467) of diabetes and fitness. Fitness was classified into 4 categories based on age-stratified quartiles of peak metabolic equivalents: least-fit (5.1 ± 1.5 metabolic equivalents; n = 1044), moderately-fit (7.6 ± 1.5 metabolic equivalents; n = 938), fit (9.4 ± 1.5 metabolic equivalents; n = 988), and highly-fit (12.4 ± 2.2 metabolic equivalents; n = 954). Annual costs per subject were quantified over an 8-year period. Age, BMI, and presence of cardiovascular disease (CVD) were similar between subjects with and without diabetes. After adjusting for age and presence of CVD, annual costs per person were higher among diabetics vs. non-diabetics. Individuals with and without diabetes in the highly-fit category had annual costs (US dollars x 103) (mean ± standard deviation) that were on average $32,178 and $30,816 lower, respectively, than individuals in the least-fit category. For each 1-metabolic equivalent higher fitness, annual cost savings per person were $5,193 and $3,603 for individuals with and without diabetes, respectively. Higher fitness is associated with lower health care costs. Cost savings associated with higher fitness are particularly evident among individuals with diabetes. The economic burden of diabetes may be reduced through interventions that target improvements in fitness.

Economic Impact of Diabetes in Africa.

This review seeks to address knowledge gaps around the economic burden of diabetes in Africa. Africa is home to numerous endemic infections and also prevalent non-communicable diseases including diabetes. It is projected that the greatest increases in diabetes prevalence will occur in Africa. The importance of this review therefore lies in providing adequate knowledge on the economic challenges that diabetes poses to the continent and describe the way forward in tackling this epidemic. Diabetes contributes to a huge amount of the global health expenditure in the world. There is a dearth of information on the economic burden of diabetes in Africa with very limited number of studies in the area. Predictions do show that Africa has the greatest predicted increase in both the burden of diabetes and associated diabetic complications but yet contributes the lowest in the global annual healthcare expenses with regard to diabetes care. In 2017, the International Diabetes Federation (IDF) estimated the total health expenditure due to diabetes at $3.3 billion. In Nigeria, the national annual direct costs of diabetes was estimated in the range of $1.071 billion to $1.639 billion per year while the estimated monthly direct medical costs per individual in Cameroon stands at $148. In Sudan, the direct cost of type 2 diabetes control was $175 per year which only included the cost of medications and ambulatory care. People with diabetes are likely to experience one or more chronic illness and a significant portion of the costs associated with these complications are attributed to the underlying diabetes. The growing epidemics of diabetes and associated diabetic complications worldwide poses catastrophic financial costs, especially in Africa where most of the expenses are paid by patients and families. The most common method used for the estimation of the economic burden of a public health problem like diabetes is the cost-of-illness approach. Cost-of-illness studies traditionally divide costs into three categories: direct, indirect, and intangible. The IDF estimated the total health expenditure due to diabetes at $3.3 billion worldwide in 2017. Most of the existing studies in Africa estimated only the direct costs. The medical direct cost of type 1 diabetes was higher than type 2. However, the estimations of costs of diabetes in many countries in Africa may be underestimated due to absence of data on the relative contribution of cost of diabetes complications.