The epidemic of Type 2 diabetes and its precursor, prediabetes, is sweeping across the globe, shortening lives, and straining the financial resources of health care systems everywhere. This impending disaster is poised to rob countries of their health, slash workforce productivity, and bankrupt health care systems ? in as little as 20 years.
Indeed, the diabetes epidemic is one of the most important issues facing the world today. More than 366 million people, or 8.3 percent of adults worldwide, are estimated to have the disease, according to the International Diabetes Federation (IDF). If current trends continue, more than 552 million people -- or almost one in 10 -- will have diabetes within the next two decades, according to the IDF.
Diabetes does not choose favorites. Type 2 diabetes is a common, chronic, potentially disabling disease that affects a broad range of individuals; anyone can develop the disease, regardless of ethnic or socioeconomic background. Being overweight is the primary risk factor for Type 2 diabetes and as waistlines stretch, so, too, does the global reach of this devastating condition. Many people do not realize that obesity, prediabetes, and diabetes are related conditions that create a dangerous yet preventable cascade of health and economic impacts.
The Economic Toll of Diabetes
To say that diabetes and prediabetes are expensive is an understatement. Diabetes and its related complications globally cost at least $465 billion in health care expenditures in 2011. In the U.S. alone, spending associated with diabetes and prediabetes is approximately $194 billion annually, or about 7 percent of total health spending. In India, according to recently conducted UnitedHealth Group research, the potential cost to the health care system is $124 billion (nearly 5.5 trillion rupees) annually. Despite these frightening projections, more than a quarter of those with diabetes in the U.S. and more than half of those with diabetes in India have not received formal diagnoses, representing lost opportunities to reduce the costs and complications of a largely preventable disease. We need to do better -- in the United States, in India, and everywhere in between.
Contrary to popular belief, Type 2 diabetes, the largely preventable form of the condition, is not just a disease that afflicts fast-food loving Americans. Rather, the global incidence of diabetes is highly correlated with the increasing income of the world's rapidly emerging nations. While the number of people with diabetes is rising sharply in virtually every country, about eight of every 10 cases now occur in low- and middle-income countries. China, for example, has nearly 90 million people diagnosed, followed by India with 61 million, with the U.S., Russia, and Brazil rounding out the top five.
The diabetes dilemma is more complex, however, than a mere numbers game. The disease isn't just affecting more people around the world -- it's striking people earlier in life, inflicting more serious health complications, and taking a more significant toll on the financial resources of families, health systems, and governments than it did in the past. In the U.S., where more than 8 percent of the population has diabetes, the problem has become so serious that children now have a shorter life expectancy than their parents -- a direct result of poor eating habits and a dwindling commitment to fitness. If the U.S. is any indication of things to come for countries like Kuwait, Lebanon, Saudi Arabia, and the United Arab Emirates -- where the prevalence rates of diabetes are more than twice the global average -- we must act quickly and decisively before an entire generation is lost.
The Good News
Here's the good news: We can win the fight against prediabetes and diabetes. The collective toll diabetes takes on us can be lightened by early, aggressive intervention. Screening tests and lifestyle changes can help prevent Type 2 diabetes. Research shows that with moderate exercise and just a 5 percent decrease in body weight, people with prediabetes can prevent or delay the onset of Type 2 diabetes. For those who already have diabetes, these practices, along with disease management, can reduce the risk of developing deadly complications, such as heart and kidney disease, nerve damage, blindness, and limb amputation. Several types of interventions have the potential to yield significant health improvements and cost savings.
One approach that has been proven to work in the U.S. is the Diabetes Prevention and Control Alliance (DPCA), a partnership launched by an unlikely band of participants -- a national community-based nonprofit organization, skilled pharmacists, a private sector health plan, and a public health leader -- to help people at risk for diabetes prevent the disease through lifestyle changes or better control their condition by improving adherence to their physicians' treatment plans.
Research shows that the two signature DPCA programs -- one focused on diabetes prevention, the other on disease management -- work. The programs are offered as a covered health benefit through UnitedHealth Group health plans in the U.S. Both have been tested through controlled trials or pilot projects with the U.S. National Institutes of Health (NIH), the U.S. Centers for Disease Control and Prevention (CDC), YMCA of USA, Indiana University, clinical centers, employers, and retail pharmacies. It is estimated that for every 100 high-risk adults who participate in the Diabetes Prevention Program (DPP), 15 cases of diabetes are avoided to the tune of $91,400 in health care costs. There is no reason that these proven programs cannot be adapted and implemented around the world.
Perhaps one of the biggest barriers to creating effective diabetes management solutions is a perceptual one -- the notion that the disease is the problem of a lazy few who just aren't interested in staying healthy. Prediabetes and diabetes, however, don't just affect the millions who are diagnosed -- the ramifications of these diseases impact us all. These conditions drain the resources of our health care systems and hack away at the productivity of our workforces. It is a global - and a national - health risk problem and needs to be dealt with as a major public policy priority -- country by country, regardless of cultural, political or economic variables.
Here's both the challenge and the opportunity: diabetes is an international public health crisis that also must be considered as a series of local emergencies. In other words, addressing this global epidemic on the ground as an individual-by-individual, family-by-family, community-based problem means being rigorous about applying community-based solutions. Whether it's the streets of Manhattan, the markets of Mumbai, or the boulevards of Moscow, it is the small lifestyle choices we make every minute of every day that make the biggest difference -- decisions made in the kitchen, in the playground, on the street, at the office, in restaurants.
We need not be blindsided by the next global crisis. There exist proven solutions that can address the gravest health issue of our time. Diabetes prevention and control programs have demonstrated their ability to scale nationally in the U.S., with nearly 7.8 million Americans now having access to DPCA programs. Curbing the global epidemic of diabetes and prediabetes should include collaboration between the government public health agencies, nonprofit organizations, and the private sector. Programs that have already been implemented have shown preliminary success. Working together, we can launch similar, culturally-appropriate initiatives in other countries that can help us get our global diabetes problem down to size. When the stakes are this high, the responsibility is one we all share.
Dr. Deneen Vojta is executive vice president and chief clinical officer of the Diabetes Prevention and Control Alliance, a UnitedHealth Group initiative.
(The above piece is part of our continuing Perspectives series designed to highlight key products and services to our readers. This paid-for Perspective was written and edited by Risk & Insurance®
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February 19, 2013
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