Type 2 diabetes: prevalence, surgery, complications & cost

PREVALENCE OF TYPE 2 DIABETES & OBESITY

• American Diabetes Association (ADA) estimates for 2007 show nearly 24 million Americans have diabetes, including 5.7 million people who have not yet been diagnosed.
• Number of Americans clinically diagnosed with diabetes nearly tripled from 1980-2006; increasing from about 6 million to nearly 17 million.
• About 57 million in the United States, age 20 years and older, have prediabetes and areat high risk of developing Type 2 diabetes.
• Type 2 diabetes accounts for 90-95% of all cases,3,4about 50% of men and 70% of women who have the disease are obese.

IMPACT OF BARIATRIC SURGERY ON TYPE 2 DIABETES

• ADA Guidelines 2009 recommend bariatric surgery be considered for adults with BMI > 35 and Type 2 diabetes, especially if diabetes is difficult to control with lifestyle and pharmacologic therapy.
• March 2009 study published in the American Journal of Medicine found overall 86.6% of patients improved or resolved Type 2 diabetes after bariatric surgery7
• January 2008 Journal of the American Medical Association (JAMA) study found 73% of patients resolved their Type 2 diabetes after gastric band surgery.
• People with morbid obesity who had gastric bypass surgery significantly reduced long-term mortality, particularly deaths from diabetes (92%), according to a study in the August 2007 issue of the New England Journal of Medicine (NEJM).
• Gastric bypass patients who had Type 2 diabetes for the shortest duration (<5 years) and with the mildest form of the disease (diet controlled) were most likely to achieve complete disease resolution after surgery, suggesting early surgical intervention is key, a 2003 Annals of Surgery study found.

COMPLICATIONS ASSOCIATED WITH DIABETES

• Diabetes is associated with increased risk for heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system disease, amputations, dental disease and complications with pregnancy3
• Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. Risk for death among people with diabetes is about twice that of people without diabetes3

COSTS ASSOCIATED WITH DIABETES

• Total estimated cost of diabetes in 2007 was $174 billion, including $116 billion in excess medical expenditures and $58 billion in reduced national productivity.
• Approximately 6.3 million Americans have diabetes without knowing it, and complications from their undiagnosed disease account for an estimated $18 billion in U.S. healthcare costs each year.
• About 1 in 5 healthcare dollars in the U.S. are spent caring for someone with diagnosed diabetes.
• The annual cost of diabetes drugs nearly doubled in only six years, rising from $6.7 billion in 2001 to $12.5 billion in 2007, according to a study in the October 2008 Archives of Internal Medicine.


1American Diabetes Association. Total Prevalence of Diabetes & Pre-diabetes, www.diabetes.org/diabetes-statistics/prevalence.jsp
2 Centers for Disease Control and Prevention. Number (in Millions) of Persons with Diagnosed Diabetes, United States, 1980–2006. [Cited 2009 May 7]. Available from: http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm.
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. 3 Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008. [Cited 27 April 2009]. Available from:
http://www.cdc.gov/nccdphp/publications/aag/ddt.htm. 4 Centers for Disease Control and Prevention Coordinating Center for Health Promotion. Diabetes: Successes and Opportunities for Population-Based Prevention and Control At-A-Glance 2009. [Cited 27 April 2009]. Available from:
http://www.americanheart.org/presenter.jhtml?identifier=3044759. 5 American Heart Association. Type 2 Diabetes. Updated 18 February 2009. [Cited 27 April 2009] Available from:
6American Diabetes Association. Standards of Medical Care in Diabetes – 2009. Diabetes Care, Volume 32, Supplement 1. January 2009. [Cited 2009 April 27].
7Henry Buchwald, et al. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-Analysis. The American Journal of Medicine. March 2009. [Cited 2009 April 27].
8 John B. Dixon; Paul E. O’Brien; Julie Playfair; Leon Chapman; Linda M. Schachter; Stewart Skinner; Joseph Proietto; Michael Bailey; Margaret Anderson Dixon JB. Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes. Journal of the American Medical Association. 2008; 299(3):316-323.
9 TD Adams. Long-term Mortality after Gastric Bypass Surgery. New England Journal of Medicine 2007; 357:753-61. [Cited 27 April 2009].
10Philip R Schauer, MD, Bartolome Burguera, MD, Sayeed Ikramuddin, MD, Dan Cottam, MD, William Gourash, CRNP, Giselle Hamad, MD, George M. Eid, MD, Samer Mattar, MD, Ramesh Ramanathan, MD, Emma Barinas-Mitchel, PhD, R. Harsha Rao, MD, Lewis Kuller, MD DrPH, and David Kelley, MD. Effects of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus. Annals of Surgery. October 2003. 234(4): 467-485. [Cited 27 April 2009].
11 American Diabetes Association. Economic Costs of Diabetes in the U.S. 2007. Diabetes Care. March 2008. [Cited 27 April 2009]. http://care.diabetesjournals.org/cgi/content/abstract/31/3/596.
12 The Economic Costs of Undiagnosed Diabetes. Population Health Management. Volume 12, Number 2, 2009.
13 National Trends in Treatment of Type 2 Diabetes Mellitus, 1994-2007. Arch Intern Med. 2008;168(19):2088-2094.