Diabetes Treatment Becoming More Complex, Costly for
Older Americans
Annual economic burden of diabetes is estimated at
$132 billion and increasing
Oct. 27, 2008 - A progressively more complex and
expensive array of treatments for type 2 diabetes is being prescribed to
an increasing number of older adults, according to a report in the
October 27 issue of Archives of Internal Medicine, one of the JAMA/Archives
journals.
"By 2050, the number of Americans with diabetes is
expected to soar to 29 million, a prevalence of 7 percent," the authors
write. In 2000, more than 11 million Americans had been diagnosed with
diabetes.
"The annual economic burden of diabetes is
estimated at $132 billion and increasing, according to the study. In
2002, more than one-tenth of U.S. health care expenditures were
attributable to diabetes."
As costs and prevalence increase, managing diabetes
also has become increasingly complex, as physicians prescribe more
medications to each patient and combine drugs from different therapeutic
classes.
To evaluate these trends, G. Caleb Alexander, M.D.,
M.S., of the University of Chicago Hospitals, and colleagues gathered
diabetes prescription information and costs from national databases.
The researchers analyzed prescription data from
U.S. patients age 35 and older with type 2 diabetes who visited a
physician's office between 1994 and 2007. Information about medication
costs was available from 2001 to 2007.
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Distribution of
Age at Diagnosis of Diabetes among Adult Incident Cases Aged
1879 Years, United States, 2005
In 2005, about one half (47%) of
the adult incident cases (i.e., cases diagnosed within past
year) of diabetes were diagnosed between the age of 45 and 59
years. About 10% were diagnosed before the age of 35 and about
18% were diagnosed at age 65 or older. Click graphic for
larger view. |
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Annual Number (in
Thousands) of New Cases of Diagnosed Diabetes Among Adults Aged
18-79 Years, United States, 19802005
From 1980 through 2005, the number
of adults aged 18-79 with newly diagnosed diabetes almost
tripled from 493,000 in 1980 to 1.4 million in 2005 in the
United States. Click graphic for larger view. |
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Percentage of
Adults with Diabetes Reporting Poor Mental Health, Poor Physical
Health, Poor Mental or Physical Health, and Inability to Do
Usual Activities at Least One Day in the Past 30 Days, United
States, 2004
In 2004, 35% of U.S. adults with
diabetes reported at least one day of poor mental health in the
past 30 days; 54.5% reported at least one day of poor physical
health; 63.1% reported at least one day of either poor mental or
physical health; and 26.5% reported at least one day of both
poor mental and physical health. Also, 32.8% of adults with
diabetes were unable to perform their usual activities at least
one day in the past month due to either poor mental or physical
health. Click graphic for larger view. |
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The analysis revealed that, between 1994 and 2007:
● The estimated number of yearly patient
visits to treat diabetes increased from 25 million to 36 million
● The average number of medications prescribed
per treated patient increased from 1.14 to 1.63
● Among visits in which any treatment was
given, the number in which only one drug was prescribed decreased from
82 percent to 47 percent
● Insulin use decreased from 38 percent in
1994 to a low of 25 percent in 2000, and then increased again to 28
percent
● The types of medications prescribed
shiftedthe use of sulfonylurea drugs decreased from 67 percent to 34
percent of treatment visits, while use of newer drugs such as biguanides
and glitazones increased, so that by 2007 these agents were prescribed
at 54 percent and 28 percent of treatment visits, respectively
The increasing use of glitazones - along with other
new treatments, including new forms of insulin and other new classes of
drugs - accounted for increases in average cost
● per prescription (from $56 in 2001 to $76 in 2007) and
● in overall medication expenditures for those with diabetes ($6.7
billion in 2001 to $12.5 billion in 2007).
"We document large shifts in patterns of diabetes
treatment and pharmaceutical expenditures across treatment classes," the
authors conclude.
"Whether increased treatment costs are balanced by
improved outcomes associated with these changes cannot be evaluated in
the absence of data comparing effectiveness and cost-effectiveness
across treatment classes.
Our findings suggest the importance of generating
new comparative data and coupling this information with clinical and
formulary guidelines that contribute to constraining costs, maximizing
glycemic control and minimizing diabetes-related morbidity and
mortality."
Editor's Note: Dr. Alexander is a Robert Wood
Johnson Faculty Scholar and is also supported by a career development
award from the Agency for Healthcare Research and Quality. Senior author
Dr. Stafford was supported by a Mid-Career Mentoring Award from the
National Heart, Lung, and Blood Institute.
About Diabetes
Also called: Adult onset diabetes, Non-insulin
dependent diabetes, Sugar
Diabetes is a disease in which your blood glucose,
or sugar, levels are too high. Glucose comes from the foods you eat.
Insulin is a hormone that helps the glucose get into your cells to give
them energy. With Type
1 diabetes, your body does not make insulin. With Type 2 diabetes,
the more common type, your body does not make or use insulin well.
Without enough insulin, the glucose stays in your blood.
Over time, having too much glucose in your blood
can cause serious
problems. It can damage your eyes,kidneys,
and nerves.
Diabetes can also cause heart disease, stroke and even the need to
remove a limb. Pregnant women can also get diabetes, called gestational
diabetes.
Symptoms of Type 2 diabetes may include fatigue,
thirst, weight loss, blurred vision and frequent urination. Some people
have no symptoms. A blood test can show if you have diabetes. Exercise,
weight control and sticking to your meal plan can help control your
diabetes. You should also monitor your glucose level and take medicine
if prescribed.
More at
National Institute of Diabetes and Digestive and Kidney Diseases
