Source: CDC, National Diabetes Statistics Report, 2014 Case for Change Why diabetes? Affects 29.1 million Americans, 9.3% of total population 20 million of those are undiagnosed 30% of Americans age 65 and older have diabetes Type 1 accounts for 1.25 million diagnoses 1.4 million Americans are diagnosed every year 86 million Americans age 20+ are estimated to have pre-diabetes 7th leading cause of death in the United States (2010) 69,071 death certificates listed diabetes as the underlying cause of death 234,051death certificates listed diabetes as contributing cause of death Source: CDC, National Diabetes Statistics Report, 2014

Source: CDC’s Division of Diabetes Translation Source: CDC’s Division of Diabetes Translation. United States Surveillance System available at hppt://www.cdc.gov/diabetes/data

Source: CDC’s Division of Diabetes Translation Source: CDC’s Division of Diabetes Translation. United States Surveillance System available at hppt://www.cdc.gov/diabetes/data

Note: Major changes in the survey methodology occurred in 2011. Source: CDC’s Division of Diabetes Translation. United States Surveillance System available at hppt://www.cdc.gov/diabetes/data Note: Major changes in the survey methodology occurred in 2011.

Cardiovascular Disease Case for Change Control Among Persons Diagnosed with Type 2 Diabetes 48.3% are within control, A1c ≤ 7.0% More than half are uncontrolled 21.4% with an A1c range of 7.1-7.9% 13.7% with an A1c range of 8.0-9.0 % 16.6% with an A1c>9.0% Comorbidities and Complications, Patients with Type 2 DM (2015) Cardiovascular Disease Hypoglycemia Nephropathy Neuropathy PAD Retinopathy 48.8% 9.1% 35.6% 36.3% 15.0% 18.0% Source: IMS Health©, Type 2 Diabetes Data Brief, 2016

Case for Change Cost of Diabetes $245 billion total estimated costs (2012) ($174 billion in 2007) $176 billion in direct medical expenses Hospital inpatient care – 43% Prescription medications – 18% Anti-diabetic agents and supplies – 12% Physician office visits – 9% Nursing/residential facility stays – 8% $69 billion in reduced productivity $1 out of every $5 spent on healthcare in the US is spent by persons with diagnosed diabetes, 50¢ directly on diabetes care Diabetes increases patient medical expenditures by 2.3x Source: American Diabetes Association, Economic Cost of Diabetes in the US in 2012, Diabetes Care, March 2013

Source: IMS Health©, Type 2 Diabetes Data Brief, 2016 Case for Change Complications from Diabetes Emergency Department (ED) utilization by patients with Type 2 diabetes (2013-2015): 18% of patients have at least on ED visit in two years Average ED visits per patient is 2.1 Readmission rates for patients with Type 2 diabetes (2013-2015): Three-day readmissions: 8.9% 30-day readmissions: 18.2% Average facility charges for patients with Type 2 diabetes (2015): Inpatient: $43,183 Outpatient: $12,253 Source: IMS Health©, Type 2 Diabetes Data Brief, 2016

Case for Change Effects on Community Vitality Absenteeism stemming from unhealthy workforce costs $153 billion annually in lost productivity Average unhealthy work days per year per full-time employee: Health Status Average Unhealthy Days Share of US Workforce Cost of Lost Productivity Normal weight, No chronic conditions (only 14% of the workforce population) 4 days / year 14% Baseline Overweight, No chronic conditions 4.32 days / year 18% $513,544,375 Overweight/obese, 1-2 chronic conditions 13 days / year 30% $32,156,821,142 Above-normal weight, 3+ chronic conditions 42 days / year $81,313,839,758 Additional workforce productivity losses: Normal weight, 1-2 conditions: 15%, 13 days, $15,563,165,458 Normal weight, 3+conditions: 5%, 42 days, $23,850,678,489 Source: Gallup-Healthways Well-Being Index, 2011

Case for Change Effects on Community Vitality Health-Related Quality of Life and Well-Being is a multi-dimensional concept to assess population health and overall perceived quality of life Includes physical, mental, emotional, and social functioning Looks at life expectancy, causes of death, and focuses on effect of health status on quality of life, such as: Positive evaluations of daily life – when one feels healthy, satisfied/content with daily life, quality of relationships, positive emotions, resilience, etc. Individual assessment of health status on social participation – includes education, employment, civic, social, and leisure activities. Citizens and community members who have improved health status are able to better engage in activities of daily life, be involved in their community, and enjoy greater quality of life Additional workforce productivity losses: Normal weight, 1-2 conditions: 15%, 13 days, $15,563,165,458 Normal weight, 3+conditions: 5%, 42 days, $23,850,678,489 Source: HealthyPeople.Gov, Health-Related Quality of Life and Well-Being, 2017

Case for Change Today alone, diabetes will be responsible for: 200 amputations 136 end-stage kidney disease treatments 1,795 cases of sever retinopathy

Source: American Diabetes Association, 2015