Compelling evidence from well-designed clinical trials has demonstrated that control of blood pressure and blood glucose and cholesterol levels can dramatically reduce diabetes complications. This often requires the use of multiple medications:
Cost-Related Medication Nonadherence
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(1) In these hard economic times, patients are scaling back on their medications or do not take them at all because of cost.
(2) Patients who forgo medications for both diabetes and chronic pain appear to be influenced primarily by economic pressures.
(3) When faced with financial hardship, people with significant medication expenses will alter behaviors in attempts to save money. They may let prescriptions go unfilled or skip doses or take smaller doses to make the prescription last longer. In a national survey of 875 older adults with diabetes, 19% reported cutting back on use of their medications because of cost, 11% reported cutting back on their diabetes medications, and 7% reported cutting back on their diabetes medications at least once a month. In order to pay for their medications, 20% reported forgoing food and other essentials, 14% increased credit card debt, and 10% borrowed money from family or friends.
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(5-6) Total prevalence of diabetes
Total: 25.8 million children and adults in the United States—8.3%
Diagnosed: 18.8 million people
Undiagnosed:
Prediabetes:
New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010.
* In contrast to the 2007 National Diabetes Fact Sheet, which used fasting glucose data to estimate undiagnosed diabetes and prediabetes, the 2011 National Diabetes Fact Sheet uses both fasting glucose and A1C levels to derive estimates for undiagnosed diabetes and prediabetes. These tests were chosen because they are most frequently used in clinical practice.
Under 20 years of age
• 215,000, or 0.26% of all people in this age group have diabetes
• About 1 in every 400 children and adolescents has diabetes
Age 20 years or older
• 25.6 million, or 11.3% of all people in this age group have diabetes
Age 65 years or older
• 10.9 million, or 26.9% of all people in this age group have diabetes
Men
• 13.0 million, or 11.8% of all men aged 20 years or older have diabetes
Women
• 12.6 million, or 10.8% of all women aged 20 years or older have diabetes
Race and ethnic differences in prevalence of diagnosed diabetes
After adjusting for population age differences, 2007-2009 national survey data for people diagnosed with diabetes, aged 20 years or older include the following prevalence by race/ethnicity:
• 7.1% of non-Hispanic whites
• 8.4% of Asian Americans
• 12.6% of non-Hispanic blacks
• 11.8% of Hispanics
Morbidity and Mortality
• In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths.
Complications
Heart disease and stroke
• In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.
• In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.
• Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
• The risk for stroke is 2 to 4 times higher among people with diabetes.
High blood pressure
• In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension.
Blindness
• Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.
• In 2005-2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had diabetic retinopathy, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss.
Kidney disease
• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008.
• In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States.
• In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States.
Nervous system disease (Neuropathy)
• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.
Amputation
• More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
• In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.
Cost of Diabetes
• $174 billion: Total costs of diagnosed diabetes in the United States in 2007
• $116 billion for direct medical costs
• $58 billion for indirect costs (disability, work loss, premature mortality)
These statics and additional information can be found in the (5)National Diabetes Fact Sheet, 2011, the most recent comprehensive assessment of the impact of diabetes in the United States, jointly produced by the CDC, NIH, ADA, and other organizations.
References:
1. Drug Benefit Trends. Miriam Chan, PharmD, CDE, Reducing Cost-Related Medication Nonadherence in Patients With Diabetes. April 2010. http://dbt.consultantlive.com
2. American Diabetes Association. Cost-related Non-adherence to Medications among Patients with Diabetes and Chronic Pain. http://care.diabetesjournals.org/
3. American Diabetes Association. Piette JD, Heisler M, Wagner TH. Problems paying out-of-pocket medication costs among older adults with diabetes. http://care.diabetesjournals.org/
4. CAP Diabetic Program. http://www.yousavemore.org/
5. Centers for Disease Control and Prevention. 2011 National Diabetes Fact Sheet. http://www.cdc.gov/
6. American Diabetes Association. Diabetes Statistics. January 2011. http://www.diabetes.org/
