ada epidemiology final 18 apr 2012 locked

8/12/2019 ADA Epidemiology Final 18 Apr 2012 Locked

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The Impact ofThe Impact ofDiabetes Mellitus in theDiabetes Mellitus in the

United StatesUnited States

Epidemiology, Costs, andEpidemiology, Costs, andFuture ProectionsFuture Proections


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Table of ContentsTable of Contents

SectionSection Slide No.Slide No.Epidemiology 3-28

Costs 29-37

Future Projections 38-43


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EPIDEMI!"!#$EPIDEMI!"!#$

Section Section


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Epidemiology of DiabetesEpidemiology of Diabetes

!i"#etes "$$ects 2%.8 million peopleo$ "ll "ges

8.3& o$ t'e (.S. popul"tion

!i"gnosed) 8.8 million

(ndi"gnosed) 7.* million

+e"ding c"use o$ ,idney $"ilurenontr"um"tic loer-lim# "mput"tion

ne c"ses o$ #lindness "mong "dults /"jor c"use o$ 'e"rt dise"se "nd stro,e

Se0ent' le"ding c"use o$ de"t'

N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics


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Diagnosed and UndiagnosedDiagnosed and UndiagnosedDiabetes in %&'&Diabetes in %&'&

.9 million people 52* ye"rs o$ "genely di"gnosed6 2%*** ere 2* ye"rs

$ t'e 2%. million :.3&; 52* ye"rs

/en) 3.* million :.8&;


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(acial)Ethnic Differences(acial)Ethnic Differencesin Diagnosed Diabetesin Diagnosed Diabetes


?"ceEt'nicity?"ceEt'nicity &&

Non-=isp"nic 'ites 7.

si"n meric"ns 8.4

=isp"nics+"tinosCu#"n meric"nsCentr"l "nd Sout' meric"ns/e@ic"n meric"nsPuerto ?ic"ns

.8 7. 7.3.33.8

Non-=isp"nic #l"c,s 2.

2**7A2**9 n"tion"l sur0ey d"t" $orpeople "ges 2* ye"rs or older


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Diagnosed and Undiagnosed DiabetesDiagnosed and Undiagnosed Diabetes


Source:2**%-2**8 N"tion"l =e"lt' "nd Nutrition E@"min"tion Sur0ey


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*e+ Cases of Diagnosed Diabetes*e+ Cases of Diagnosed Diabetes


Source:2**%-2**8 N"tion"l =e"lt' "nd Nutrition E@"min"tion Sur0ey estim"tes projected to t'e ye"r 2**


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.cdc.go0

County"e-el Estimates of DiagnosedCounty"e-el Estimates of DiagnosedDiabetes ./0, 1dults 2%& years, %&&3Diabetes ./0, 1dults 2%& years, %&&3

Percent

* A .%

. A 8.*

8. A 9.4

9.% A .

5 .2


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*umber of 1mericans +ith*umber of 1mericans +ithDiagnosed Diabetes, '43&%&&4Diagnosed Diabetes, '43&%&&4

.cdc.go0


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1nnual, 1ge1dusted Incidence (ate1nnual, 1ge1dusted Incidence (ateof Diagnosed Diabetes5, %&&6%&&7of Diagnosed Diabetes5, %&&6%&&7

MMWR. 2**86%7:43;)9-73.


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Pre-alence of !-er+eight and !besityPre-alence of !-er+eight and !besity1mong 1dults +ith Diabetes1mong 1dults +ith Diabetes

MMWR. 2**46%3:4%;)*-*8.

C!C "n"lysis o$ pre0"lence o$ o0ereig't"nd o#esity "mong (.S. "dults 52* ye"rsit' pre0iously di"gnosed di"#etes

0ereig't or o#esity) 8%.2&

#esity) %4.8&


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SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outhStudy !-er-ie+Study !-er-ie+

Popul"tion-#"sed o#ser0"tion"l study o$p'ysici"n-di"gnosed di"#etes "mongyout' 2* ye"rs o$ "ge

1niti"ted in 2***

Funded #y C!C N1= Collects d"t" $rom centers

4 geogr"p'ic"lly #"sed :Color"do 'io

Sout' C"rolin"


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379 yout' it' di"#etes in " popul"tiono$ 3.% million

0er"ge "ge "t di"gnosis) 8.4 ye"rs

0er"ge dur"tion o$ di"#etes)

% mont's :r"nge 38-* mont's; Estim"ted pre0"lence o$ (.S. yout' "ged

*-9 ye"rs it' di"#etes in 2**

.82 c"ses per *** yout':9%& C1) .78-.87 per *** yout';

C"ncer) .24 per ***st'm") 2* per ***

SE?C= $or !i"#etes in Bout' Study roup. Pediatrics. 2**68)%*-%8.

SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outh(esults(esults


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SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outh&4 $ears by (ace)Ethnicity&4 $ears by (ace)Ethnicity


N=


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SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outh'&'4 $ears by (ace)Ethnicity'&'4 $ears by (ace)Ethnicity


Pre-alence

N=


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SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outhPopulation Estimates, %&&'Population Estimates, %&&'

Estim"ted num#er o$ c"ses o$ di"#etesmellitus e@tr"pol"ted $rom SE?C= d"t"

%439 yout':9%& C1) %*489-%8248;

/"jority :78.7&; *-9 ye"rs o$ "ge Non-=isp"nic 'ite) 2& o$ t'ose 2*

ye"rs #ut 7& o$ "ll c'ildren it' di"#etes

328* c'ildren * ye"rs o$ "ge Non-=isp"nic 'ite) *& o$ popul"tion

#ut 77& o$ "ll c'ildren it' di"#etes



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PrediabetesPrediabetes

1n 2**%-2**8 #"sed on $"sting glucose or'emoglo#in C le0els predi"#etes "sdetected in

3%& o$ "dults "ges 2* ye"rs "nd older

%*& o$ "dults "ges % ye"rs "nd older

n estim"ted 79 million "dults "ges3* ye"rs "nd older

People it' predi"#etes '"0e "n incre"sedris, o$ de0eloping type 2 di"#etes 'e"rtdise"se "nd stro,e



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#estational Diabetes#estational Diabetes

?"nge $rom 2&A*& o$ pregn"ncies Postp"rtum %&A*& o$ omen it'

gest"tion"l di"#etes "re $ound to '"0edi"#etes usu"lly type 2


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Complications of DiabetesComplications of Diabetes

=e"rt dise"se "nd stro,e =ypertension

lindness eye pro#lems

?en"l dise"se Ner0ous system dise"se

mput"tions

!ent"l dise"se Complic"tions o$ pregn"ncy

t'er complic"tions


C li i f Di bC li ti f Di b t


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1n 2**4 o$ di"#etes-rel"ted de"t'certi$ic"tes "mong people "ges 5% ye"rs8& noted 'e"rt dise"se "nd & sto,e

dults it' di"#etes '"0e 'e"rt dise"se

de"t' r"tes 2A4 times 'ig'er t'"n t'oseit'out6 stro,e ris, is 2A4 times 'ig'er

1n 2**%-2**8 o$ "dults "ges 52* ye"rsit' sel$-reported di"#etes 7& '"d#lood pressure 54*9* mm=g or usedprescription medic"tions $or 'ypertension

Complications of DiabetesComplications of Diabetes8eart Disease, Stro9e, 8ypertension8eart Disease, Stro9e, 8ypertension


C li i f i bC li ti f Di b t


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!i"#etes is le"ding c"use o$ ne c"ses o$#lindness "mong "dults "ges 2*A74 ye"rs

$ people it' di"#etes "ged 54* ye"rs4.2 million :28.%&; '"d di"#etic

retinop"t'y in 2**%-2**8 %%*** :4.4& o$ t'ose it' di"#etes;

'"d "d0"nced di"#etic retinop"t'y t'"tcould le"d to se0ere 0ision loss

Complications of DiabetesComplications of Diabetes:lindness, Eye Problems:lindness, Eye Problems


C li i f Di bC li ti f Di b t


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1n 2**8 di"#etes "s le"ding c"use o$,idney $"ilure "ccounting $or 44& o$ "llne c"ses o$ ren"l $"ilure

48374 people it' di"#etes #eg"n

tre"tment $or end-st"ge ren"l dise"se:ES?!;

2*229* people it' ES?! due to di"#etesere li0ing on c'ronic di"lysis or it' ",idney tr"nspl"nt

Complications of DiabetesComplications of Diabetes(enal Disease(enal Disease


C li ti f Di b tC li ti f Di b t


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*&A7*& o$ people '"0e mild to se0ere$orms o$ ner0ous system d"m"ge 1mp"ired sens"tion or p"in in $eet

or '"nds

Sloed digestion o$ $ood in t'e stom"c' C"rp"l tunnel syndrome

Erectile dys$unction

Se0ere $orms "re " m"jor contri#utingc"use o$ loer-e@tremity "mput"tions)>*& occur in people it' di"#etes

Complications of DiabetesComplications of Diabetes*er-ous System Disease*er-ous System Disease



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Oral

medication

only58%

No

medication16%

Insulin only

12%

Insulin

and oral

medication14%

Treatment of DiabetesTreatment of Diabetes



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Deaths 1mong People +ith DiabetesDeaths 1mong People +ith Diabetes

1n 2**7 di"#etes se0ent' le"ding c"use o$de"t' #"sed on de"t' certi$ic"tes

7382 underlying c"use

**22 contri#uting c"use

+i,ely to #e underreported "s " c"useo$ de"t'

0er"ll ris, $or de"t' "mong t'ose it'

di"#etes is "#out tice t'"t o$ people it'simil"r "ge #ut it'out di"#etes


1 Di t ib ti f D th1 Di t ib ti f D th


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1ge Distribution of Deaths1ge Distribution of Deaths1ssociated +ith Diabetes1ssociated +ith Diabetes

Age 70+206,71

7!%

Age "18

488

0%

Age 18#!4

1,181%

Age !5#44

5564

2%

Age 45#54

16,66!6% Age 55#51!,07

5%

Age 60#64

17,6!4

6%

Age 65#6

20,656

7%

meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%. Figure 4.


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C!STSC!STS

Section 2Section 2


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Economic Costs of Diabetes, %&&7Economic Costs of Diabetes, %&&7

Cost o$ !i"#etes /odel

ot"l cost o$ di"#etes) G74 #illion

G #illion) e@cess medic"le@penditures

G27 #illion to tre"t di"#etes directly

G%8 #illion to tre"t di"#etes-rel"tedc'ronic complic"tions "ttri#uted todi"#etes

G3 #illion e@cess medic"l costs

G%8 #illion) reduced n"tion"l producti0ity

meric"n !i"#etes ssoci"tion.Diabetes Care

. 2**863)%9-%.

Medical E pendit esMedical E;penditures


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Medical E;pendituresMedical E;penditures1ttributed to Diabetes, %&&71ttributed to Diabetes, %&&7

=ospit"l inp"tient c"re :%*&;

!i"#etes medic"tion "nd supplies :2&;

?et"il prescriptions to tre"t complic"tionso$ di"#etes :&;

P'ysici"n o$$ice 0isits :&;

meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%.

Costs Incurred by People +ith aCosts Incurred by People +ith a


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Costs Incurred by People +ith aCosts Incurred by People +ith aDiagnosis of Diabetes in %&&7Diagnosis of Diabetes in %&&7

0er"ge "nnu"l e@penditures) G744

G49 "ttri#uted to di"#etes

n "0er"ge people it' di"gnoseddi"#etes '"0e medic"l e@penditures 2.3

times 'ig'er t'"n t'ose it'out di"#etes G in G% 'e"lt' c"re doll"rs is spent

c"ring $or someone it' di"gnoseddi"#etes

G in G* 'e"lt' c"re doll"rs is"ttri#uted to di"#etes


8ealth (esource Use8ealth (esource Use


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8ealth (esource Use8ealth (esource Use1ttributed to Diabetes, %&&71ttributed to Diabetes, %&&7

meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%. "#le %.

=e"lt' resource=e"lt' resource

ge :ye"rs;ge :ye"rs;

ot"lHot"lH4%4% 4%-44%-4 55%%

Institutional care

=ospit"l inp"tient d"ysNursingresidenti"l $"cilityd"ys

2%29

7%8*3

4%24387

2422%*%9

Outpatient care

$$ice-#"sed p'ysici"n 0isitsEmergency 0isits=ospit"l outp"tient "nd

$reest"nding "m#ul"tory

surgic"l center 0isits=ome 'e"lt' 0isits=ospice c"re d"ys?et"il prescriptions

73%34993*7

*4

%8

2%%29842%3%

893922

729%

3*8*82*84888

8449%

8884

473%%7%73*

2738892

7%37

HNum#ers do not necess"rily sum to tot"ls #ec"use o$ rounding

Indirect CostsIndirect Costs


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Indirect CostsIndirect Costs1ttributed to Diabetes, %&&71ttributed to Diabetes, %&&7

meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%. "#le 4.

Cost componentCost component Producti0ity lossProducti0ity loss

ot"l costot"l cost

"ttri#ut"#le"ttri#ut"#le

to di"#etesto di"#etes

:G #illions;:G #illions;

ProportionProportion

o$ indirecto$ indirect

costs :&;costs :&;


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Mortality CostsMortality Costs1ttributed to Diabetes, %&&71ttributed to Diabetes, %&&7

meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%. "#le .

Prim"ry c"usePrim"ry c"use

o$ de"t'o$ de"t'ot"l (Sot"l (S

de"t'sde"t's

!e"t's "ttri#uted to di"#etes!e"t's "ttri#uted to di"#etes

!e"t's!e"t's

& o$& o$

tot"ltot"l

o$ (So$ (S

de"t'sde"t's

I"lue o$I"lue o$

lostlost

producti0ityproducti0ity

:millions o$:millions o$

doll"rs;doll"rs;

!i"#etes 77*** 77*** **.* 9%2*

?en"l dise"se 43*** 2%*** %7.4 2

Cere#ro0"scul"rdise"se

%%*** %9*** 37. 3849

C"rdio0"scul"rdise"se 739*** 23*** .% 47

ot"lot"l NHNH 284***284*** NHNH 29*229*2

Hot"l comprises mort"lity $or re"sons ot'er t'"n t'ose listed 'ere

Economic Costs of PrediabetesEconomic Costs of Prediabetes


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Economic Costs of PrediabetesEconomic Costs of Prediabetesand Diabetes, %&&7and Diabetes, %&&7

=ig'er medic"l costs) G%3 #illion

Producti0ity loss) G% #illion

ot"l cost) G28 #illionJ

G74.4 #illion $or di"gnosed di"#etes

G8 #illion $or undi"gnosed di"#etes

G2% #illion $or predi"#etes

G3 million $or gest"tion"l di"#etes

ot"l #urden $or e"c' meric"n reg"rdlesso$ di"#etes st"tus) G7** "nnu"lly

!"ll / et "l. Health Affairs. 2**629:2;)297-3*3.


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(educing the :urden of Diabetes(educing the :urden of Diabetes

urden o$ di"#etes complic"tions onindi0idu"ls 'e"lt' c"re system signi$ic"nt

/uc' o$ t'e cost is pre0ent"#le t'roug'

1mpro0ed diet "nd e@ercise

Pre0ention initi"ti0es to reducepre0"lence o$ di"#etes comor#idities

1mpro0ed c"re $or people it' di"#etesto reduce need $or costly complic"tions

(nderst"nding economic cost m"jordetermin"nts o$ costs c"n 'elp in$ormmoti0"te decisions to reduce #urden



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FUTU(E P(!


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IDF Diabetes Atlas 4t'ed. K1ntern"tion"l !i"#etes Feder"tion 2**9.

IDF #lobal Proections for *umber ofIDF #lobal Proections for *umber ofPeople +ith Diabetes, %&'&%&=&People +ith Diabetes, %&'&%&=&

Estimated *umber of People +ithEstimated *umber of People +ith


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Estimated *umber of People +ithEstimated *umber of People +ithDiabetes >orld+ide, %&'& and %&=&Diabetes >orld+ide, %&'& and %&=&

IDF Diabetes Atlas 4t'ed. K1ntern"tion"l !i"#etes Feder"tion 2**9.

CountryerritoryCountryerritory2**2**

/illions/illions CountryerritoryCountryerritory2*3*2*3*

/illions/illions

1ndi" %*.8 1ndi" 87.*

2 C'in" 43.2 2 C'in" 2.

3 (S 2.8 3 (S 3.*

4 ?ussi"n Feder"tion 9. 4 P",ist"n 3.8% r"Lil 7. % r"Lil 2.7

erm"ny 7.% 1ndonesi" 2.*

7 P",ist"n 7. 7 /e@ico .9

8 M"p"n 7. 8 "ngl"des' *.49 1ndonesi" 7.* 9 ?ussi"n Feder"tion *.3

* /e@ico .8 * Egypt 8.

Modeling the Future U S :urden ofModeling the Future U S :urden of


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Modeling the Future U?S? :urden ofModeling the Future U?S? :urden ofDiabetes Through %&6&Diabetes Through %&6&

Constructed system o$ dyn"mic eu"tions

1niti"l pre0"lence :percent"ge o$popul"tion it' di"gnosedundi"gnoseddi"#etes;

1ncidence :percent"ge o$ popul"tionit' nely di"gnosed di"#etes;

/igr"tion

/ort"lity

Pre0"lence o$ predi"#etes Eu"tions used to model $uture #urden o$

di"#etes on (.S. "dults t'roug' 2*%*

oyle MP et "l. Popul Health Metr. 2**68)29.


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1nnual U?S? Diabetes :urden in %&6&1nnual U?S? Diabetes :urden in %&6&

y 2*%* pre0"lence o$ tot"l di"#etes:di"gnosed "nd undi"gnosed; is projectedto incre"se $rom in * "dults to #eteen in % "nd in 3 "dults

1ncidence) $rom 8 in *** to % in *** +"rgely "ttri#uted to t'ree ,ey $"ctors

ging o$ t'e (.S. popul"tion

1ncre"sing siLe o$ 'ig'er-ris, minoritypopul"tions

!eclining mort"lity "mong t'ose it'di"#etes


Total U S 1dult PopulationTotal U S 1dult Population


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Total U?S? 1dult PopulationTotal U?S? 1dult PopulationDiabetes Pre-alence ProectionsDiabetes Pre-alence Proections

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