Costs, Complexity of Treating Diabetes Increasing Steadily, Says Study

The annual economic burden of diabetes in the United States was well over $100 billion nearly a decade ago, and the problem, say researchers, is expected to get much worse in the coming years. With the annual number of diabetes treatment-related patient visits topping 35 million in 2007 and the average number of medications patients take for their disease also climbing steadily, one FP expert is pointing to lifestyle changes as a major player in helping patients with diabetes take charge of their disease.

According to research cited in a study published last fall in the Archives of Internal Medicine, the economic impact of diabetes in 2002 was estimated at $132 billion, with more than 10 percent of all U.S. health care expenditures that year attributed to the disease.

As of 2000, more than 11 million Americans had been diagnosed with diabetes, says the study; the number of diagnosed cases of the disease is expected to reach 29 million by 2050. Moreover, the study researchers estimate that the annual number of patient visits to treat diabetes rose from 25 million in 1994 to 36 million in 2007. During that same period, the average number of medications prescribed per treated patient increased from 1.14 to 1.63.

It is figures such as these that lead Michael Parchman, M.D., the Mario E. Ramirez Endowed Distinguished Professor in the department of family and community medicine at the University of Texas Health Science Center, San Antonio, to hail nutrition and exercise as key factors in preventing and coping with diabetes.

"We need to encourage people to be more physically active to reduce progression to diabetes or to manage their diabetes," he said. "It doesn't have to mean joining a gym. It doesn't mean they have to become marathon runners. If they're not walking, I tell my patients to start walking -- vigorous walking -- for at least 30 minutes a day. Most people don't even do that."

Parchman, who is the AAFP representative to the National Diabetes Education Program convened by the NIH's National Institute of Diabetes and Digestive and Kidney Diseases and the CDC, said that patients who can't squeeze a 30-minute walk or workout into their daily schedule still would benefit from two 15-minute exercise sessions or even three 10-minute sessions.

Coincidentally, the American College of Sports Medicine recently updated its recommendations for physical activity in all adults. That group previously had recommended a minimum of 150 minutes of moderate to intense activity per week to improve health and between 200 and 300 minutes per week to achieve long-term weight loss.

In its new recommendations, the college recommends 150 to 250 minutes of exercise per week to prevent weight gain or to produce a modest weight loss and 250 minutes or more per week to produce significant and lasting weight loss.

The college, which estimates that 66 percent of American adults are overweight or obese, also recommends strength and resistance training as part of an overall exercise routine to reduce health risks -- including the risk of developing diabetes.

A recent study from the CDC and NIH shows that nearly 13 percent of adults in the United States have diabetes, but 40 percent of those individuals haven't been diagnosed yet.

The same study also notes that nearly 30 percent of the overall population is at risk for diabetes, and 40 percent of Americans have some hyperglycemic condition.

About one-third of the elderly population has diagnosed or undiagnosed diabetes, the study found, and three-quarters have either diabetes or prediabetes. In addition, the prevalence of diabetes is as much as 80 percent higher in non-Hispanic blacks and Mexican Americans than in the white population.

"The evidence isn't strong enough that we should be screening everyone for diabetes or prediabetes," Parchman said. "There are certain people whose risk is much higher. The screening for diabetes should be tailored to risk factors."

In its Recommendations for Clinical Preventive Services, the AAFP agrees with the U.S. Preventive Services Task Force recommendation to screen for type 2 diabetes in asymptomatic adults with sustained blood pressure -- treated or untreated -- greater than 135/80 mm Hg. The Academy has concluded, however, that the evidence is insufficient to assess the balance of benefits and harms of diabetes screening in asymptomatic adults with blood pressure of 135/80 mm Hg or lower.