The Economic, Emotional and Physical Costs of Diabetes: Facts & Figures Felicia Hill-Briggs, PhD, ABPP 2018 President of Health Care and Education, American Diabetes Association Professor of Medicine, Sr. Director Population Health Research and Development, Johns Hopkins Medical Institutions, Baltimore, MD Healthy Churches 2020. November 15, 2017. Hilton Head, S.C.

November is American Diabetes Month. November 14th is World Diabetes Day.

The Global Costs of Diabetes 451 million people globally have diabetes; 1 out of every 11 people around the world. On track to reach 693 million people with diabetes by 2025 (in just 8 years). Global economic cost of diabetes = $830 billion each year. Diabetes is Increasing especially fast in the poorest countries, due to people adopting Western diets and lifestyles, leading to increased overweight/obesity and lack of physical activity. Source: International Diabetes Federation, November 2017

The Human Costs of Diabetes In the U.S.

Every 21 seconds someone in the U.S is diagnosed with diabetes. Diabetes Figures, United States 9.3% of the population Working-aged adults prevalence - number of adults, 18 -64 years, per 1,000 people (2012 data): http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf By Age: 20-44 years = 4.1 per 100. 45-64 years = 16.2 per 100. (Numbers can’t be summed because the denominators are different) Working-aged adults incidence – number of adults, 18-64 years, per 1,000 people (2014 data): https://www.cdc.gov/diabetes/statistics/incidence/fig3.htm By Age: 18 -44 years = 3.2 per 1,000. Age 45 – 64 = 10.5 per 1,000. Total = 14 per 1,000. Prediabetes: In January of this year, the ADA, along with the CDC, AMA, and the Ad Council launched the National Prediabetes Campaign to make the public, employers, and healthcare providers aware that type 2 diabetes can be prevented or delayed. The National Diabetes Prevention Program (NDPP), through the CDC, is available to employers and health plans to implement. With the NDPP, whose community implementation has been underway over 10 years now, we are seeing a change in diabetes incidence rates in the U.S. Over the last 2 years, the upward trend in new cases has leveled off and shows signs of being reversible. ADA SOC recommend 3rd party insurers cover. Disparities in access, which can be addressed by employers and health plans. Every 21 seconds someone in the U.S is diagnosed with diabetes. Sources: American Diabetes Association; Centers for Disease Control and Prevention

Social Determinants of Health, World Health Organization (WHO) The social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.  http://www.who.int/social_determinants/en/

Source: Centers for Disease Control and Prevention (CDC) Racial/Ethnic Minorities Have Higher Diabetes Burden Prevalence (%) of diagnosed diabetes, ages 20 years and older Source: Centers for Disease Control and Prevention (CDC)

The Poor Carry Higher Diabetes Burden Braveman PA, et al. Copyright © American Public Health Association 2010. All Rights Reserved. Used With Permission.

Complications of Diabetes 75% 80 – 97% of people with diabetes have diabetic eye disease (retinopathy); leading cause of noncongenital blindness in U.S., with 2,000 to 24,000 new cases each year 40% of people with diabetes will have end-stage kidney diease (nephropathy), needing dialysis or transplant Death from heart disease is 2-4 times higher in people with diabetes Stroke is 3 – 4 times more likely in people with diabetes

60% of all non-traumatic below the knee amputations are due to diabetes, accounting for 80,000/year Cancer People with diabetes have a 2-4 times higher rate of death from all cancers Brain health 74% increased risk of all types of dementia 56% increased risk of Alzheimer’s dementia 127% increased risk of vascular dementia

African Americans and Diabetes Complications African Americans with diabetes, compared with Whites with diabetes, have: 15% higher prevalence of nerve disease (neuropathy) 34% higher prevalence of stroke 50% higher prevalence of diabetic eye disease (retinopathy) 6-fold higher prevalence of kidney disease leading to end-stage renal disease 3-6 fold higher prevalence of amputation 11

The Economic Costs of Diabetes To Health care

Diabetes Health Care Costs The total cost of diabetes and prediabetes in the U.S. is $322 billion. One 1 out of every five 5 health care dollars is spent caring for a person with diabetes One 1 out of every three 3 Medicare dollars is spent on diabetes care Source: American Diabetes Association

57.6% spent on pharmaceuticals Among 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion in spending, including 57.6% spent on pharmaceuticals 23.5% spent on ambulatory (outpatient) care. Dieleman et al. JAMA, 2016

The Costs of Diabetes To people with diabetes

Medical Spending for People With Diabetes Medical costs for people with diabetes are 2.3 times higher than for people without diabetes. Personal health care spending for people with diabetes increased by $64.4 billion over the past 15 years. The average price of insulin increased nearly 3 times between 2002 and 2013, and prices continue to rise. Source: American Diabetes Association

The Emotional Cost of Diabetes Up to 45% of people with diabetes report Diabetes Distress 1 in 4 people with diabetes has Depressive disorder 1 in 5 people with diabetes has Anxiety disorder 3 in 4 older adults with diabetes will experience Dementia

Diabetes Costs People Years of Life, Work, Wages, and Productivity Global total economic burden of diabetes is 1.31 trillion USD (1.8% of the world GDP): 49% of the cost is due to drop-out from the workforce 46% is due to early death 4% is due to being absent from work (sick-days) 2% is due to reduced productivity while at work. $245 BILLION USD Total costs and lost work and wages for people with diagnosed diabetes in U.S. Source: Bonner et al. Lancet Diabetes Endocrinology, June 2017

Diabetes’ Contribution to the U.S. Economy Drug Discovery – as of 2016, 171 new drug therapies were in development for treating type 1 and type 2 diabetes. (Zhang, Gregg. Lancet, 2017) Medical device and equipment discovery Maintenance care and therapeutics High-cost procedures

New Solutions? national Diabetes Prevention

Launch of the National Prediabetes Campaign American Diabetes Association (ADA) Centers for Disease Control and Prevention (CDC) American Medical Association (AMA) Ad Council

Launch of the National Prediabetes Campaign What every person should do: Take the Prediabetes Risk Test and find out your score. See your doctor if your score is in the risk range, and get screened with a blood test. Start a lifestyle-based Diabetes Prevention Program. American Diabetes Association (ADA) Centers for Disease Control and Prevention (CDC) American Medical Association (AMA) Ad Council

ADA and CDC Partnership BROADER DISSEMINATION ADA local offices ADA Diabetes Self-Management Education (DSME) programs CDC grant for ADA programs in Hispanic communities in key states

Felicia Hill-Briggs, PhD, ABPP Thank You! Felicia Hill-Briggs, PhD, ABPP fbriggs3@jhmi.edu