Diabetes Overview and Costs

Introduction

Diabetes is a chronic metabolic disorder that affects many members of the population. There are various types of diabetes, including diabetes that only affects pregnant women (gestational diabetes) and types caused by diseases of the pancreas or concomitant to cystic fibrosis. However, the more common forms of diabetes are classified as diabetes mellitus (DM), type I and type II. Even those diabetes disorders that have various known etiologies are typically grouped as “Other Specific Types.” Regardless, the costs of the management of diabetes are considered substantial and represent a significant financial cost both domestically and globally. DM affects over 9.4% of the U.S. population, costing about $327 billion a year in healthcare dollars.

Cost Implications in the Management of Diabetes

According to reports by Cinahl Information Systems, approximately $327 billion healthcare dollars were spent in 2018 for medications and supplies for the management and treatment of DM in the United States (“Diabetic Drug Management: Health Care Costs,” 2018). This figure also includes money spent on prescription drugs to treat DM-related complications. Cinahl Information Systems also reports that the number of individuals who are diagnosed with DM increases by about 1 million each year. For instance, in 2007, total costs related to the treatment of DM were about $174 billion. This includes $116 billion in direct costs, and $58 in indirect costs (“Diabetes Management: Health Care Costs,” 2018). In 2013, that figure went up to $174 billion, which represents a 41% increase. Cinahl Information Systems also reports that about one in five healthcare dollars is spent annually in caring for people who have DM. This is about 20% of all healthcare dollars. 

Overview of the Disease Process and Complications

As mentioned, diabetes is a chronic condition that is known to alter carbohydrate, protein, and fat metabolism. Its cause originates through an absence of insulin by the pancreas via either progression or production inability. It is broadly classified as being either type I or type II (Al-Goblan, Al-Alfi, & Khan, 2014). Type I typically presents in children and type II in adults; however, with the obesity problem becoming almost epidemic, type II is increasingly being reported in young adult and juvenile populations. 

The etiology of diabetes is constructed through damage to the pancreatic cells caused by either environmental factors of infectious agents. Its primary pathophysiology (in type I) is thought to be autoimmunity; there are known associations between type I and Graves’ Disease, Hashimoto’s thyroiditis, and Addison’s disease (Al-Goblan, Al-Alfi, & Khan, 2014). With type II, the median age of onset is 12-16 with the occurrence of puberty; type II is more prevalent in the U.S., while type I is found more globally (Baynest, 2015). As Baynest (2015) writes “Presently, as many as 50% of people with diabetes are undiagnosed. Since therapeutic interventions can reduce complications of the disease, there is a need to perform a risk assessment to detect diabetes early in its course. The risk of developing type II diabetes increases with age, obesity, and a lack of physical activity” (Barest, 2015 p. 2). There are many complications to DM. 

As Baynest (2015) writes, DM presents with acute complications such as hypoglycemia and diabetes ketoacidosis; chronic complications like microvascularity, diabetic retinopathy, and diabetic nephropathology. Other complications and associated conditions include impaired growth and development, hypothyroidism, various associated immune disorders, celiac disease, adrenal insufficiency (usually Addison’s disease), vitiligo (a skin condition), lipodystrophy, necrobiosis lipoidica diabeticorum, fatty liver disease not caused by the consumption of alcohol, and other non-infectious disorders including limited joint mobility and edema (Baynest, 2015).  

Overall, DM is a costly disorder through both its treatment and for supplies. There are many forms of diabetes, but most present as either type I or type II. The disorder also can cause a great many complications, and therefore, early diagnosis is essential.

References

Al-Goblan, A., Al-Alfi, M., & Khan, M. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy, 7, 587-591.

Baynest, H. (2015). Classification, pathophysiology, diagnosis and management of diabetes mellitus. Journal of Diabetes and Metabolism, 6(5), 1-9. DOI: I: 10.4172/2155-6156.1000541

“Diabetes Management: Health Care Costs.” (2018). Cinahl Information Systems, 1-4.

“Diabetic Drug Management: Health Care Costs.” (2018). Cinahl Information Systems, 1-6.