Diabetes Incidence to Double, Costs to Triple by 2025


Nearly 30 million new patients will be diagnosed with diabetes by 2025 at a cost of $514 billion. Can we stop the prediction from becoming reality?

A new report released by the Institute for Alternative Futures (IAF) uses data from a recent study published in Population Health Metrics and the CDC’s 2011 National Diabetes Fact Sheet to project the “medical and societal cost of diabetes” through the year 2025. The prediction is sobering.

Though the IAF and CDC differ in their estimations of the number of Americans living with diabetes in 2010 (IAF says 32.3 million, CDC says 25.8 million; both agree that 79 million Americans have prediabetes) both recognize that the epidemic continues to grow at a rapid pace.

The IAF model predicts that the portion of the population with diabetes “will increase by 64% by 2025…to 53,100,000” between 2010 and 2025, with a concurrent cost increase of 72% to $514.4 billion.

Though these figures are depressing, they are not necessarily inevitable. The authors note that the data assumes “a steady, but conservative, reduction in the number of people with complications due to better awareness of the risks of diabetes, earlier screening and intervention, and more effective therapies.”

It is evident from medical literature “that relatively simple lifestyle changes, such as modest weight loss and increases in regular physical activity, can often prevent those most at risk, including those with prediabetes, from developing diabetes, or significantly delay the onset of the disease.”

But working on a plan for better health in today’s world is not going to be done in consultation with health care professionals alone. The Internet is the elephant-in-the-room of every encounter between patients and providers, for good or ill, and when it comes to chronic conditions such as diabetes, the ill end of that equation can be very damaging to a patient’s well-being.

Recognizing this reality — calling it “the clutter of health care information on the Internet” – the American Association of Clinical Endocrinologists and Takeda Pharmaceuticals North America, Inc. are teaming up to build an “online resource” for individuals with type 2 diabetes that will be “reviewed and evaluated by top medical experts.”

The site, which is expected to debut later this year, “will offer a compendium of existing reliable resources, specific to type 2 diabetes, divided into various categories (eg, management, lifestyle, and tools) and reviewed by experts, to help health care professionals guide their patients and caregivers as they attempt to cut through the clutter of the many resources available.”

"Inaccurate or incomplete information can lead to unnecessary stress or confusion among patients with type 2 diabetes," said George Grunberger, MD, founder and chairman, Grunberger Diabetes Institute, Bloomfield Hills, MI, and AACE Board member. "With the ever increasing number of Americans living with type 2 diabetes, and with so many resources already available, we need to make it easier for health care professionals, patients and caregivers to access reputable and reliable resources, as a foundation for treatment and care decisions."

Hot spotters

Perhaps the AACE-Takeda partnership will fit in well with the movement towards Accountable Care Organizations. In an article written for the New Yorker, Atul Gawande profiles two “hot spotting” initiatives in New Jersey, in which a team of health care professionals takes on the task of treating the sickest five percent of patients (who account for 60% of total health care costs) in Camden and Atlantic City, a number of whom have diabetes.

Gawande, in a follow up piece, writes that respondents to his article fell into three camps: defeatists, catastrophists, and triumphalists.

Catastrophists, he says, view hot spotting as a potential for mandated lifestyle advice via government health insurance agents, while triumphalists think hot spotting is “too good not to be made universally available.”

But Gawande contends that the defeatists “strike me as having the most compelling argument.” The defeatists argue that “local successes are too complex and require too much expertise and dedication to survive at larger scale—to survive in the real world where ordinary people don’t want to change and aren’t going to be all that smart or dedicated.”

Gawande admits that “solutions for great and complex societal problems are rare” and that hot spotting may only guarantee local success, but then again, so what? The current model of health care delivery in the US demonstrably fails those most in need and is very poor at controlling overall costs. If hot spotting, or some other method for that matter, can deliver better quality care at lower cost, then why not attempt to adapt its methodology on a larger scale, whether it be the state, regional, or national level?

The status quo always feels more comfortable than the Great Unknown, but when inaction means nearly 30 million people will join the diabetes ranks in the next 15 years at an additional cost of more than $200 billion, what’s the incentive to stand still?

HCPLive wants to know:

Do you think hot spotting is an efficient means for treating diabetes?Can that model of care reverse the trend of increasing diabetes incidence and costs?If you are not sold on hot spotting, what solutions would you advocate to change the current paradigm?How effective will initiatives such as the AACE-Takeda diabetes resource center be in helping patients live healthier lives?To what extent do you feel the Internet plays a role in your patients' adherence to their diabetes treatment regimens?

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