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Economic Toll of Diabetes Begins Early

ByANAHAD O'CONNOR

| January 9, 2012, 4:00 pm47

Diabetes may be more than a hazard to health. A new study shows that young adults with the disease havelower lifetime earnings and fewer job prospects than their peers.

The new research helps quantify the nonmedical costs of a burdensome disease that afflicts nearly 10percent of Americans. The study did not distinguish between Type 2 diabetes, which is closely linked toobesity and inactivity and is by far the most common form of the disease, and Type 1, sometimes calledjuvenile diabetes, which may be linked to immune, genetic and environmental factors. But both types of

diabetes are on the rise in young people: About 215,000 Americans younger than 20 have Type 1 or Type2 disease.
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The study, which tracked 15,000 people over a period of 14 years, from high school through their early30s, found that people with diabetes could expect $160,000 less in earnings over the course of theirlifetimes compared with those without the disease. They had lower rates of finishing high school and wereless likely to move on to college than young adults who were not diabetic. By age 30, a person withdiabetes is 10 percent less likely to have a job, in part because of reduced education.

The findings, published in the journal Health Affairs, are important because they reflect that diabetics

may be having some negative consequences pretty early on in the course of life, said Dr. MichaelRichards, a physician and doctoral candidate in the department of health policy and administration at Yaleand an author of the study. They also beg the question of what the underlying influences that are drivingthese associations may be.

One driving force, Dr. Richards suspects, may be the difficulty in balancing school or job demands withthe management of a chronic disease. Employers may also be less likely to hire someone with diabetesbecause they fear they will take more sick days or be less productive or more of an insurance burden thanother workers. People with diabetes themselves may also be reluctant to seek out better-paying jobs forfear of losing health benefits, a phenomenon known as job lock.

Diabetes could also affect the incentives for people in terms of how much schooling they want toacquire, and it could also change incentives for employers who might expect larger medical spending fortheir diabetic employees, Dr. Richards said. Probing further into these potential mechanisms is going tobe a goal of future work.

Earlier studies have shown that chronic disease and other aspects of a persons health can pose barriers inthe job market. The overweight and obese, for example, face job discrimination and often earn less thantheir thinner counterparts. And researchers have previously shown that diabetes can hamper productivityand hurt employment prospects among older Americans. But Dr. Richards and his colleagues wanted towork backward to see if a similar pattern might occur with younger patients.

They found that high school students with diabetes had a dropout rate 6 percent greater than that of theirpeers, and were 10 percent less likely than others to find a job when looking for employment. The studycontrolled and adjusted for the effect of being overweight, a factor in Type 2 diabetes, as well as otherfamily, environmental and demographic factors and diabetes was still shown to have a direct andindependent effect.

The researchers were surprised to find that diabetes also had an intergenerational effect. Young people inthe study, regardless of whether they had diabetes, were 6 percent less likely to attend college if they hada parent with the disease. One explanation is that parents with diabetes might have fewer financial

resources and less time and energy to devote to their children because of the encumbrance of managingthe disease, Dr. Richards said. Its a novel and intriguing finding, he said, and if it is indeed a realphenomenon, then it suggests that the societal burden of diabetes has perhaps been underestimated.

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1.Mom of type 1Vancouver, BC

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I find this study totally misleading considering the fact that they don't differentiate between type 1and type 2. Type 2 as the article hinted to can be based on lifestyle, diet and activity...Type 1 hasnothing to do with those attributes and is often diagnosed in young children with no hint of lifestyle

issues, etc. My daughter was diagnosed when she was almost 3 with type 1. She will grow upproductive, fit and as healthy as the rest...probably more so considering the extreme importance thatwe place on balancing our diet and activity. I think this article paints a very negative picture ofpeople with diabetes. I know my daughter will not grow up thinking that she is any less valuable inthe workforce because of the way we embrace life and teach her how to overcome any obstacle thatcomes her way including her diabetes!

Feb. 2, 2012 at 10:17 a.m.ReplyRecommend

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2.KsmahoneyCorpus Christi, TX

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wow, often you hear the health risks with this, but not the finacial. Hopefully storys like this willhelp people relize what they need to do to stay healthy. Losingtogether.com

Jan. 12, 2012 at 10:10 a.m.ReplyRecommend


3.HalNew Amsterdam

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This is extremely sad to hear, and highlights for early intervention for those at risk for diabetes,

whether its is self-directed or via the medical system.

http://questorganic.com/search?q=diabetes

Jan. 11, 2012 at 8:33 p.m.ReplyRecommend


1.HealthreformCalif

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The food was changed in the USA, UK and Australia 30 years ago when dangerous foodchemicals from the USA was allowed into European. The food today causes stubborn insulinIf you have stubborn insulin you hold fat and have a hard time losing weight.

You can eat very little and the weight still does not come off. Stubborn insulin will hold fat
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and diets won't work. When researchers used a specialized diabetes diet on overweight peopleall lost weight eeven those who did not have diabetes. The diet proved food chemicals arewhy dieting does not work. The specialized diabetes diet reversed food chemicals and peoplelost weight. Thiis proved that Type 2 diabetes is reversable Herehttp://spirithappy.org/wp/2011/09/14/diabetes-now-kills-4-6-million-ever...

Jan. 11, 2012 at 11:01 p.m.

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4.A SmithPortland, ME

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I doubt that this has much to do with Type 1 diabetics. I suspect this result is largely due to Type IIdiabetics and the strong correlation with obesity. In physical jobs, surely it is harder for obesepeople to get a lot of physical work done with a positive attitude. When was the last time you heardsomeone say, "I have so much more energy and enthusiasm ever since I became 70 poundsoverweight. Now my feet don't hurt. My back doesn't hurt. My knees don't hurt. I'm just feeling sogreat." In most of the business world, nobody would ever talk about weight but they do routinelyuse very indirect references to appearance when considering people for particular jobs. People aredescribed as being ideal for "client facing" and "maybe not so good for client facing." It is not

uncommon for client facing jobs to pay twice that of non-client-facing jobs. To have a client facingjob, you need to speak well and have an appearance that shows you try very hard to take care ofyourself. The problem is that the same suit and haircut on an athlete and an obese person rarelylooks better on the obese person. If obese people looked sharper in their clothes then the hundredsof clothing companies in this world would prefer them for modeling.

Jan. 11, 2012 at 8:33 p.m.ReplyRecommend2


5.Alana UngerSausalito, CA

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CKS--

After 49 Yrs of Type 1 and as many years of research and reading, I have concluded that the ADAand JDRF fall short of an interest in getting at the bottom of these pharmaceutical cash cows. I
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didn't think this way for so many decades, but I now am more interested in what "outside"resources, such as The Lee Iacocca Foundation can do.



6.William SchafferLas Vegas

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Some comments: Health status was accounted for, according to the abstract, which means that theremust have been some account taken for obesity - which directly relates to the higher %age of Type2 diabetics in lower socioeconomic levels. This relates the much higher incidence of obesity inthose communities [especially Hispanic & Native American] and the lack of readily available goodnutrition, recreational facilities and medical care. So, obesity/Type2 was accounted for to at leastsome extent, perhaps fully.Another factor to emphasize is the known higher incidence of depression among diabetics. Thisrelates to poor self-care and ambition. Diabetes needs to have higher analytical skills andknowledge to adequately self-care, however this may be much harder to accomplish with moodissues. The depression may also account for some diminished job-hunting skills.

The cost of medical appointments is much higher for me than diabetes supplies - endo, cardio,nephro, opthalmo, podiatrist - paying out of pocket at a low-cost clinic with a pharmacy withdiscounted diabetes supplies. Such is the way for a Type 1 for 37 years. Just waiting for Medicareto kick in.

Jan. 11, 2012 at 4:46 a.m.ReplyRecommend2


7.pigeoncalos angeles

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As a type 2 diabetic of normal weight, I often get angry at the assumption that the disease is myfault. A fairly sizable percentage of us cannot control our disease with diet and lifestyle changes -because we have always eaten properly and exercised as we should. Sometimes it's just hereditary.
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Also, an area ripe for investigation is the interrelationship between type 1 and type 2, as familiesoften have members with both. I know that they're supposed to be two different diseases, but Ibelieve that there's a continuum as, for example, in the case of LADA or type 1.5. In any event,both types of diabetes are costly, and when type 2 persists, insulin is often needed.



1.nicthommiMichigan

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Well, unfortunately people would much rather use your disease as one more reason why thefatties should be rounded up and exterminated.

No matter what is published, people see the typical type 2 diabetic as being an overweight,sedentary person who "deserves" to be sick.

You see in this comment thread that even your comrades in illness, the type 1 diabetics, arepainting themselves as being uniformly thin, healthy, and undeserving of the illness. They are

desperate to apply numbers so high to the type 2 folks to prove that no one should care thatyou have a chronic illness.

I'd imagine that if you aren't overweight and somehow tell people that you have type 2diabetes, they will assume you are a former fatty who deserves to have the disease and whodrives up their insurance costs (what a stupid and fallacious argument but it's one peoplemake ALL of the time).

Such is life. A lot of people who have no scientific or medical knowledge promote thispompous moralizing rather than focus on cures.

I mean, isn't the only thing that we know for sure is different about type 1 and type 2diabetics the pathology of the disease? Some people are going to get one of the other nomatter what they do, and the fact that some people get type 2 b/c of "lifestyle" shouldn't be anexcuse to condemn anyone in my opinion.

Jan. 11, 2012 at 8:33 p.m.Recommend5

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8.StanWashington, DC

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Type 1 diabetics are successful in all walks of life, such as professional golfer Scott Verplank, NFLquarterback Jay Cutler, Actress Sharon Stone, Supreme Court Justice Sonia Sotomayer, musicianBrett Michaels, comedian Kevin Nealon and many others. I personally know many Type 1s haveexceled in business, law and medicine.

Type 1 is a disease that can be managed with proper diet, exercise and blood glucose control.Unlike a Type 2 diabetic, who tends to be overweight with a poor diet, a well-managed diabetic istypically in excellent physical condition as the result of regular exercise and eating right.

A recent study published in the USA Today found that the life expectancy of a Type 1 diabetic iswithin a few years of a non-diabetic and closing. By not separating Type 1 out from Type 2s thisarticle does not give an accurate picture of Type 1 diabetic life and career outcomes.



9.Sandyh00kJacksonville, Florida

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I've been a type 1 diabetic since i was a kid. My dad and all his siblings had type 2. In no instancedid i or my family allow diabetes to impact our education, or our careers.

If one maintains a healthy lifestyle by including exercise, healthful foods and moderation inamounts of food eaten, as well as taking all needed diabetes medication, a person can be quitesuccessful in spite of this disease.

I completed a rigorous doctoral program in psychology, my father owned a garage and worked as acar mechanic, an uncle was chief of surgery at a busy hospital, an aunt was busy as a hospitalvolunteer, and a cousin with type 2 and a heart transplant is a busy golf pro.

To help other diabetics to be successful in managing their disease, medical professionals and

insurance companies should include psycho-therapy to help patients develop the discipline, andovercome any fears, that will affect their ability to avoid the majority of issues that come withdiabetes.
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Furthermore, there is no reason for a potential employer to turn down a job applicant in anticipationof sick days due to diabetes. Potential employers are not allowed to ask about health conditionsduring job interviews. Once a person is hired, employers may not ask about specific healthconditions. If they do, that company should be reported to Economic Employment OpportunityCommission (EEOC: http://www.eeoc.gov/)



1.

98.6North Carolina

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The laws that protect employees with disabilities from discrimination do not apply to manysmall companies. For example, the federal ADA covers employers of 15 or morehttp://www.eeoc.gov/facts/ada17.html Small companies are also the ones that struggle themost to offer health insurance, and one high-cost employee or dependent can have ameaningful impact on the company's premiums for all workers.

I am glad you have not encountered this problem, but it has affected others.

Jan. 11, 2012 at 4:46 a.m.Recommend1


10.

AnneSan Francisco CA

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I've had type 1 diabetes for 23 years--I earned a full tuition scholarship for a good university plus,later, a generous, fully funded fellowship for a PhD program at a prestigious university. However, Iwould have to agree that, in my case, I did not seek out a higher paying job (after several years inmy current position) because of my good health benefits. I agree that the study made a big mistakeby not distinguishing between type 1 and type 2. I assume they have the data on which type ofdiabetes people in their study had? Was there no difference or did they just not report it?? How isanyone going to get at a solution if this most basic distinction is not made?
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Looking forward to a cure (that doesn't entail a lifetime of buying medical supplies).


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11.Mom3boysNJ

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I have a 28 year old who was diagnosed with Type 1 at the age of 8. He graduated from a topcollege and now works abroad in a country where top notch health care is tough to find. He is herein the USA several months a year so is followed by a medical team here. I worry whether he willfind work here with a company that provides good health insurance - a necessity for Type 1diabetics. Many of my friends are against Obama's health proposals but I know for my son it will bea good thing especially since people with chronic pre existing conditions cannot be deniedcoverage.



12.LizWashington, DC

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Quote from the original research paper:

"As noted above, we were unable to distinguish between type 1 and type 2 diabetes in our data set.However, the absence of such a distinction should not be considered a major problem.Commonalities between the two types continue to emerge as clinical knowledge of diabetesevolves. These common features further blur the line between the two, if in fact one exists at all."

This statement alone is just absurd. I don't see how someone who acquired type 1 diabetes as atoddler and must take insulin to merely survive, has ANYTHING in common with the vast majority

of type 2 diabetics who develop the condition later in life and are able to control it with diet,exercise, and maybe some oral medications. If you know a type 1 diabetic, you know that thisstatement is simple ridiculous.
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1.Sandyh00kJacksonville, Florida

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Actually, i do not think the quote is all that absurd. No matter what type of diabetes a personacquires, the complications of unregulated blood sugar are the same.

In my family i have Type 1, but my dad, his siblings, and all my cousins developed Type 2.None were overweight! All were active! But their genes ruled the day.

Some people develop diabetes due to hormonal irregularies or side effects of somemedications. Perhaps the majority of Type 2s may indeed need to make alterations in theirlifestyle, however it is wrong to presume the diet and exercise alone will heal all Type 2s.

The bottom line is that diabetes, 1 or 2, is a dangerous condition. If a diabetic's A1C level isnot well controlled, and sometimes even when it is controlled, secondary and dangeroushealth problems will ensue.



13.hartsmartwinnipeg canada

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Obesity rules, aided by food guides and diets which prompts my proposal: A book burning of allfood guides and diets literature, to be replaced by an anti-obesity campaign based on weight gaindetection and seventy years of close food contact.


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14.marymaryWashington, DC

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Is there any chronic disease that is not life-limiting? One can observe that the outliers who attaingreat successes "notwithstanding' are uniformly championed, but is that not because they areunusual? Wondering where this notion of diabetics in particular being limited leads.



15.Dr. Sara M.Texas

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It seems that education is an important factor both in the onset of Type II diabetes and the potentialharm it may cause down the road. Of those children who are most at risk for diabetes, howcomprehensive is their health education? Do they have access to proper nutrition? Are they allowedample time for exercise during the day?www.losingtogether.com




16.LeAnna J. CareyWashington DC/Northern Virginia

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Excellent information that brings attention to the importance of addressing healthy lifestyle choicesearly in life so that they become a behavior. For example, it is important not to assume that allfamilies have a beneficial knowledge of wellness - label reading, the importance of sleep, or
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exercise. Approaching lifestyle competencies differently will be a key factor in keeping our nextgeneration healthy.LeAnna J. Carey, @thehealthmaven

Jan. 10, 2012 at 8:56 p.m.Reply

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1.hartsmartwinnipeg canada

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Will this nonsense ever stop? Healthy lifestyle choices are not a matter of an announcement--but performance. A disaster.Anti-obesity holds the aces, I own two of them. Aside from my personal seventy yearinvolvement in food.

My proposal; a Book Burning: Food guides and diets. They have cause a trillion dollarsworth of pain and suffering.

Jan. 11, 2012 at 1:29 a.m.

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17.LizWashington, DC

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The authors of this study failed to differentiate between type 1 and type 2 diabetes, and this is aHUGE flaw of this study. The conditions are completely different. About 50% of people with type1 diabetes, an autoimmune condition that results in a complete destruction of the insulin-producingcells in the pancreas, are diagnosed as children. Type 1 diabetics REQUIRE insulin, and there is noamount of dieting and exercising that can change that. The amount of monitoring and vigilance thatis required to manage type 1 diabetes is intensive and this can have huge impacts on the ability topursue higher education and maintain a job. Type 2 diabetes, is often diagnosed in adulthood and,in many cases, can be managed with diet and exercise.

I really wish studies of this nature would differentiate between the types of diabetes, because theyare completely different conditions. In addition, I really want to see a study that looks at the

ersonal costs t e 1 diabetics incur. We have to have insulin to survive and this results in a HUGE


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personal cost. As a type 1 diabetic who uses an insulin pump, I spend more than $300/month on thebasic things I need to survive (pump supplies, insulin, test strips). Requiring these things has a hugeimpact on personal finances, not to mention one's ability to even obtain health care coverage in thiscountry.

Jan. 10, 2012 at 8:55 p.m.

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1.Tom TrowbridgeSanta Fe, NM

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Absolutely correct! The differences between the two "types" of diabetes are so that theyreally should have different names. As a "type

Jan. 11, 2012 at 1:28 a.m.Recommend


2.GwenRockville, MD

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In addition, by not differentiating, we have no way of knowing whether it is actuallydiscrimiantion based on weight which is well documented. The way the article reads, this was

only looked at in terms of high school students.Finally, the claim that employers are less likely to hire diabetics is nonsense. It would requirethe employer to know ahead of time and no one announces that during an interview.



3.98.6
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North Carolina

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Gwen, you say that no one discusses diabetes during an interview. In fact, many jobs askabout medical restrictions and/or require physicals. Diabetes may or may not be relevant to a

particular job. Also, people who apply for jobs are not always strangers to those whointerview them.

Your point about weight discrimination is good, though.



18.JayKayTeePhoenix

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Tara,You state that 215,000 young adults under 20 have diabetes and that diabetes is on the rise withinthis same group. What does this number mean as a percentage of the population of this age group?

And how much has the number risen in ?? window of time?



1.LizWashington, DC

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It's also important to distinguish between type 1 and type 2 diabetes. I would venture to guessthat most people with a "diabetes" diagnosis who are under the age of 20 have type 1 diabetes(although this may have changed due to the increase in obesity in our country). We still DONOT know what causes type 1 diabetes, but it is thought to be a combination of genetics and

something in the environment that triggers the autoimmune response. Type 2 diabetes doeshave a genetic component, but there are also lifestyle factors. Finally, there are also peoplewho do not fit neatly into either category, and this is an area where much research is still
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nee e .



19.David ChowesNew York City

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This may be due to confounding variable(s).

Jan. 10, 2012 at 8:54 p.m.

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20.VanessaDanville, IL

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I'd like to know if these findings are limited to the U.S. or could be replicated in countries withuniversal access to heath care.



21.MurielLondon

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Is this really the economic toll of diabetes or does it result from the wilfull indulgence that often

leads to Type 2 diabetes? Some of these people just want sympathy and will accept noresponsibility for having eaten and lounged themselves into "diabesity". Disease or no disease, aresuch eo le likel be to earners?
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1.JamesNorthern Nevada

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This also applies to the higher unemployment rates among the obese in general. There are,after all, still a good many jobs for which a certain degree of physical fitness is required (e.g.

the UPS guy who dropped a 40 lb package at my door just now), which reduces their pool ofpotential jobs.



2.SarahNew York, NY

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Good point, Muriel. After all, if we've learned one thing from the recent credit crisis, it's thata character flaw is a clear impediment to career success!

(I don't think you hit EVERY mindless stereotype there; you didn't suggest that they were allout for government benefits; try harder next time.)



22.MicheleIsrael
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As presented in this article, this study raises many more questions than it answers, and the fact thatit doesn't distinguish between Type 1 diabetes and Type 2 is ridiculous.

Young people with Type 1 are usually physically fit (other than having the disease) and work veryhard to stay healthy and avoid complications. These kids tend to be highly disciplined and self-motivated about their diets and exercise, characteristics that spill over into the rest of their life.

They often excel in school and in the workforce.

Kids who develop Type II diabetes often -- but not always, of course -- have underlying problems,such as obesity, which can stem from lack of exercise and poor eating habits. They may have lowself-esteem and little family support, feeding into the vicious cycle. Unfortunately, the outlook forthese kids -- unless someone helps them -- may be less than optimal in later life.

I'd now like to see a study that distinguishes between the two groups of young people, to seewhether there is a difference in their level of education and earnings later in life. I'd also like toknow whether, as mentioned in the article, diabetics (and others with chronic health problems)

really do stay in lower-level jobs because they need the health care. If true, it says a great deal aboutthe need for universal health care.



1.LizWashington, DC

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Could not agree more!! And what is really needed here is a study that looks at cost burdensthose of us living with type 1 incur. If you have type 1 diabetes, you have to have insulin tosurvive. We type 1s face a far greater financial burden because of our condition and it'sfrustrating that no one is looking at this.

As a type 1, I definitely fit your description - physically fit, hard-working, disciplined. I'vehad to be to survive. And I think I've definitely excelled in both school and work not despiteof, but BECAUSE of, type 1 diabetes. If anything, being a type 1 has given me some wickedmath, analytical, and organizational skills.




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2.Gwen

Rockville, MD

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That confuses me. Better paying jobs tend to have better, not worse, health benefits. I canunderstand staying in a job you don't like rather than starting your own firm to maintainbenefits, but not avoiding higher paid employment.




3.TaraSan Francisco

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What about investigating the effects of drugs for ADHD as well as other psychoactive drugson children? Might they be contributing to the development of obesity and diabetes?

Jan. 31, 2012 at 8:54 p.m.Recommend


23. DavidPhiladelphia, PA

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Although the reasons for this are probably quite complex, but in part almost certainly reflect thestigma carried by those with Type 2 diabetes. The article correctly states that Type 2 diabetes "...isclosely linked to obesity and inactivity...and Type 1...may be linked to immune, genetic andenvironmental factors," but few people realize that Type 2 has a far stronger genetic componentthan does Type 1.

Jan. 10, 2012 at 8:50 p.m.Re l
http://well.blogs.nytimes.com/2012/01/09/economic-toll-of-diabetes-begins-early/?comments#permid=8http://well.blogs.nytimes.com/2012/01/09/economic-toll-of-diabetes-begins-early/?comments#permid=9:31http://well.blogs.nytimes.com/2012/01/09/economic-toll-of-diabetes-begins-early/?comments#permid=9:9


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24.Joe B.Madison, WI

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Very frustrating that once again a published study does not differentiate between type 1 and type 2diabetes. This practice not only produces rather meaningless results, useless for health professionalsand diabetics themselves, but also serves to further in the public mind the myth that the twodiseases are basically the "same." Health professionals, and so-called reputable health journals,

should know better and set a better example.



25.Paula M. ScottNo. Co.

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I am very suspicious of the role that drug companies play in all these latest research studies. Mostof us know that the criteria for diabetes has become broader every year. Elsewhere I read today thatsomeone is recommending that all hospitalized people have their blood glucose measured. Why?What is going to be done with these measurements? Is this part of "we'll cure all disease so we will

all live forever"? What nonsense!



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