The number of those with diabetes covered by Medicare will rise from 8.2 million to 14.6 million, the researchers predict. Medicare spending on diabetes will jump from $45 billion to $171 billion.

“If we don’t change our diet and exercise habits or find new, more effective and less expensive ways to prevent and treat diabetes, we will find ourselves in a lot of trouble as a population,” said the study’s lead author Elbert Huang, MD, assistant professor of medicine at the University of Chicago.

“Without significant changes in public or private strategies,” the authors wrote, “this population and cost growth are expected to add a significant strain to an overburdened health care system.”

The new estimates are far more rigorous, and more troubling, than previous predictions.

* A 1991 study stated that the number of Americans with diabetes would double, from 6.5 million in 1987 to 11.6 million by 2030, which, as it turns out, is less than half the number of cases in 2009. “These projections stress the importance of prevention and education,” the authors declare. “The requisite change in life style, exercise, or nutrition habits will be more difficult than if a drug is developed for treatment.”

* A 1998 study foretold more cases sooner: 22 million US cases by 2025. “Worldwide surveillance of diabetes is a necessary first step towards its prevention and control, which is now recognized as an urgent priority.”

* A 2001 study predicted 29 million cases by 2050. The authors of that study warned that their projection may be “more alarming than previously believed,” adding that the “economic cost of diabetes is already staggering.”

* A retrospective 2008 study confirmed the predicted trends, showing that the number of Americans diagnosed with diabetes rose steadily from 10 million in 1994, to 14 million in 2000, to 19 million in 2007, and the annual cost–just for drugs–for people affected by diabetes nearly doubled in six years, rising from $6.7 billion in 2001 to $12.5 billion in 2007.

The most recent and alarming prediction may even be a bit conservative. It is based on the assumption that the prevalence of the overweight and obese in the United States will remain relatively stable.

Although obesity levels have gone up steadily for many years, the authors predict that the obesity levels for the non-diabetic population will top out in the next decade, then decline slightly, from 30 percent today to about 27 percent by 2033. “Despite recent trends in obesity rates,” Huang explained, “we anticipate that the population will reach an equilibrium in obesity levels, since we cannot all become obese.”

The 2009 Diabetes Care study places increased emphasis on changes in demographics, advances in treatment, and the natural history of this disease, including the timing and frequency of its costly complications. Much of the increase in cases and in costs will be driven by aging “baby boomers,” the 77 million Americans born between 1946 and 1957 who are approaching the age of retirement, diabetes complications, and federal health insurance.

Various characteristics of the modern natural history of diabetes and its treatments contribute to increasing the costs of diabetes for the population. People with diabetes are now being diagnosed at younger ages. Thanks to better treatments, they are living longer. This leads to a longer history of disease, opportunities for more aggressive therapies, and time to accumulate complications, which are costly to treat. Diabetes is the leading cause of blindness, end-stage kidney disease and amputations.

The study was done to help forecast the impact of alternative policy scenarios as Congress debates changes in the health care system, particularly to Medicare.

“The public policy implications are enormous,” said co-author Michael O’Grady, PhD, senior fellow at the National Opinion Research Center at the University of Chicago. “This a serious challenge to Medicare and every other health plan in the country. The cost of doing nothing is the significant increase in the pain and suffering of America’s population and a financial burden that will threaten the financial viability of public and private insurers alike.”

“We built this model to improve the budgetary and health outcome information available to federal policymakers,” the researchers explained. It provides a rigorous assessment of the future burden of diabetes and can also be used to provide estimates of the impact of alternative policy scenarios. They predict that the growth in diabetes costs will exceed current projections of total Medicare spending.

Source: John Easton
University of Chicago Medical Center

According to the Centers for Disease Control and Prevention (CDC), the number of diabetes cases nationwide increased by 90 percent over the past decade. In Philadelphia alone, 11 percent of people have the disease, and that’s 3 percent higher than the national average. In 2008, the estimated direct and indirect cost of diagnosed diabetes was $174 billion. Not only do costly complications of diabetes, such as heart disease, amputation, and blindness have a significant impact on the U.S. health system and its rising costs, but some complications can lead to death. In 2007, for example, diabetes killed nearly 300,000 people across the U.S.

“Although chronic diseases like diabetes are among the most common and costly health problems, they are also among the most preventable,” said Joseph A. Frick, president and chief executive officer, IBC. “Our sponsorship of Step Out and the enthusiastic participation of our associates, in addition to our strong focus every day on obesity and diabetes-related prevention, management, and support programs, is a clear demonstration of how we are here for our members every step of the way.”

Prevention is key

Though type 1 diabetes can often be tied to genetics, type 2 is largely attributed to lifestyle choices. Sadly, a trend of unhealthy lifestyles is plaguing children and adults alike. According to the CDC, in the last two decades type 2 diabetes has been reported among U.S. children and adolescents with increasing frequency. Health care providers are finding more and more children with type 2 diabetes — a disease usually diagnosed in adults 40 years or older.

“Research shows that as weight increases to levels of ‘overweight’ and ‘obese’ so do the chances of developing coronary heart disease and type 2 diabetes,” said Richard L. Snyder, M.D., senior vice president Health Services, IBC. “It is imperative that children develop good eating habits and get the exercise they need to live active, healthy lifestyles and avoid these diseases and their serious complications. We are proud of the prevention programs we have in place to tackle childhood obesity and diabetes.”

Because childhood obesity is on the rise and is a leading contributor to type 2 diabetes in children, IBC introduced Health eTools for Schools, a unique, web-based program designed to help area schools promote student wellness and combat childhood obesity. Now, further plans are in place to help promote better nutrition and physical activity planning in schools. One example is the Pennsylvania Departments of Health and Education’s Active Schools initiative. Through this program, sponsors like IBC contribute grants to local schools that must use the funding for physical activities and programs for students.

Other Blue partners throughout the country are getting involved in various initiatives as well. The Blue Cross and Blue Shield Association recently launched a pilot program in five states called the Pediatric Obesity and Diabetes Prevention Pilot Program. Doctors within the pilot program receive prevention toolkits containing reference materials and educational, behavior-changing tools to share with patients and parents.

In addition to prevention-related programs, IBC continues to support members that are already living with diabetes through a variety of programs. The award-winning Connections(SM) Health Management Program targets members with diabetes and other chronic conditions through one-on-one support with health coaches. IBC also offers six free nutritional counseling visits and fitness reimbursements for logging time at the gym to help members form or maintain healthy eating habits and exercise routines — both of which can help members better manage, control, and prevent chronic diseases like diabetes.

About Independence Blue Cross

Independence Blue Cross is a leading health insurer in southeastern Pennsylvania. Nationwide, Independence Blue Cross and its affiliates provide coverage to nearly 3.3 million people. For more than 70 years, Independence Blue Cross has offered high-quality health care coverage tailored to meet the changing needs of members, employers, and health care professionals. Independence Blue Cross’s HMO and PPO health care plans have consistently received the highest ratings from the National Committee for Quality Assurance.

Independence Blue Cross supports comprehensive health care reform that would extend coverage to all Americans, reduce costs, and improve quality. We also advocate reform that builds on the current employer-based system that currently serves 170 million Americans.

Source: Independence Blue Cross

The expert group evaluated existing scientific information and agreed upon practical recommendations for different groups of diabetes patients with regard to timings, frequencies and target values for SMBG, which go beyond current national and international guidelines. In general, diabetologists recommend an overall target of 6.5 percent for the HbA1c value for most patients. According to the consensus group, this target should be modified based on individual patient needs: For women who are pregnant or are planning to have a baby, a value of less than six percent is recommended. Patients with a high risk of hypoglycaemia or with unawareness of hypoglycaemia should not get over seven or 7.5 percent. Lower levels should be aimed for, but only if they can be achieved safely, since severe hypoglycaemia should be avoided in all patients to reduce the risk of severe complications.

With regard to overall targets for preprandial blood glucose, a value of less than six mmol/L respectively 108 mg/dL is the average. This target may be modified for individual patients like children, “high-risk” patients with known coronary artery disease or severe hypoglycaemia as well as pregnant women. The value for postprandial blood glucose should not exceed 7.8 mmol/L respectively 140 mg/dL. Here, testing is advised to be performed two hours after the meal and stressed as one of the key elements of optimal SMBG.

Also the recommended measuring frequency and timing depends on individual conditions such as the patient’s treatment regimen. Experts differentiate between six patients’ groups. Newly diagnosed Type 2 diabetics, for example, should test their blood glucose values three to five times a week to learn about the effects of lifestyle and medications on their metabolism. Instead, patients undergoing an intensified insulin treatment as well as “high risk” patients should check their values several times a day, especially postprandial or at nighttimes. For those experiencing severe hypoglycaemia even an increased frequency of nocturnal testing is recommended.

As a general rule, the consensus paper states that individual glycaemic targets should always be agreed upon between patient and the healthcare professional. Discussing the current results are advised to take place every three to six months, including pre and postprandial blood glucose values, HbA1c targets as well as lifestyle changes or circumstances complicating the effective control of diabetes, such as pregnancy, severe hypoglycaemic episodes or altered medication orders. “Changes in any of these factors should trigger an immediate adaptation of target values to ensure optimal treatment outcome and avoid late complications”, says Professor Schnell.

About Bayer HealthCare Diabetes Care

Bayer HealthCare, Diabetes Care as part of the Medical Care Division supports customers in 100 countries and stands in a long tradition of leading the way in diabetes care product innovation since the introduction of CLINITEST reagent tablets in 1941. The face of diabetes care was changed in 1969 when the first portable blood glucose meter and test strips were introduced. Certain features of Bayer’s blood glucose monitors such as No Coding technology and no interference from maltose and galactose make diabetes management easier. Today, Bayer HealthCare Diabetes Care offers an unparalleled choice in diabetes management systems and comprehensive support including education, tools and resources designed to simplify life with diabetes.

Bayer HealthCare Diabetes Care global headquarters is located in Tarrytown, New York, in the United States and operates as part of Bayer HealthCare LLC, a member of the worldwide Bayer HealthCare group. The Headquarters for the region Europe-MERA is located in Basel as part of Bayer Consumer Care AG, in Basel.

About Bayer HealthCare

The Bayer Group is a global enterprise with core competencies in the fields of health care, nutrition and high-tech materials. Bayer HealthCare, a subsidiary of Bayer AG, is one of the world’s leading, innovative companies in the healthcare and medical products industry and is based in Leverkusen, Germany. The company combines the global activities of the Animal Health, Bayer Schering Pharma, Consumer Care and Medical Care divisions. Bayer HealthCare’s aim is to discover and manufacture products that will improve human and animal health worldwide.

(1) O. Schnell et al., Diabetes, Stoffwechsel und Herz, 2009, 4, 285-289

Forward-Looking Statements

This release may contain forward-looking statements based on current assumptions and forecasts made by Bayer Group or subgroup management. Various known and unknown risks, uncertainties and other factors could lead to material differences between the actual future results, financial situation, development or performance of the company and the estimates given here.

Source: Bayer HealthCare