Will You Have Diabetes in 2020?

Diabetes, one of the fastest-growing diseases in the United States, currently affects about 27 million Americans (American Diabetes Association [ADA], 2010).  Another 67 million Americans are estimated to suffer from pre-diabetes, an asymptomatic condition in which blood sugar levels are elevated, but not yet high enough to be diagnostic of diabetes.  By 2020, it is forecasted that more than 50 percent of Americans will have diabetes or pre-diabetes (United Health Group, 2010).

Diabetes is an insidious disease and many diabetics are initially asymptomatic.  In fact, more than 60 million Americans do not know that they have pre-diabetes. Experts predict that one out of three children born in the year 2000 will develop diabetes in their lifetime, putting them at risk for cardiac and renal disease, neuropathy, blindness and limb amputations.

Experts also anticipate that the sharp increase in the number of Americans with diabetes and pre-diabetes will escalate total healthcare spending by the end of this decade to an annual cost of almost $500 billion. This can have far reaching consequences for us all.

An October 2010 report by the United Health Group’s Center for Health Reform & Modernization offers practical solutions that could improve health and life expectancy, while also saving up to $250 billion over the next 10 years, if programs to prevent and control diabetes are adopted broadly and scaled nationally.

Key solution steps include lifestyle interventions to combat obesity and prevent pre-diabetes from progressing. Medication control programs and lifestyle intervention strategies are also recommended strategies to improve diabetes control. The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) agree that lifestyle changes and modest weight reduction can prevent or delay the onset of diabetes by as much as 58 percent.

The ADA has updated screening recommendations in the 2010 Standards of Care guidelines. The current recommendations include testing of all overweight (BMI ≥25 kg/m2) adults with any of the following additional risk factors:

•Physical inactivity
•A first-degree relative with diabetes
•Members of a high-risk ethnic population (African American, Latino, Native American, Asian American)
•Women who delivered a baby weighing >9 lb or were diagnosed with gestational diabetes
•Hypertension (≥140/90 mmHg or on therapy for hypertension)
•HDL cholesterol level <35 mg/dl (0.90 mmol/l) and/or a triglyceride level >250 mg/dl (2.82 mmol/l)
•Women with polycystic ovary syndrome
•A1C ≥5.7%, IGT, or IFG on previous testing
•Other clinical conditions associated with insulin resistance (e.g., severe obesity)
•History of CVD

In the absence of the above criteria, testing for diabetes should begin at age 45 years.  If results are normal, testing should be repeated at least at three-year intervals, with consideration of more frequent testing depending on initial results and risk status.

References:
American Diabetes Association (ADA), 2010. Summary of Revisions for the 2010 Clinical Practice Recommendations. Diabetes Care January 2010 33:S3; doi:10.2337/dc10-S003. Retrieved November 29, 2010 from:  http://care.diabetesjournals.org/content/33/Supplement_1

Centers for Disease Control and Prevention (CDC, 2010). Overweight and Obesity. Data and Statistics. Retrieved November 29, 2010 from: http://www.cdc.gov/obesity/data/index.html
United Health Group’s Center for Health Reform & Modernization (2010). Retrieved November 29, 2010 from: http://www.unitedhealthgroup.com/news/rel2010/Diabetes_Alliance_Fact_Sheet_National_Data.pdf