Medical World News®: Diabetes Data

CDC Report: US Diabetes Population Tops 30 Million

More than 30 million Americans have been diagnosed with diabetes, and 100 million are living with diabetes or prediabetes, the CDC says in a new report that shows how this growing health emergency hits hardest those least able to manage the disease or its effects. At current trends, 1 in 3 American adults will have diabetes by 2050.¹

Type 2 diabetes (T2D), in particular, is most common among the poor, minorities, those with less education, and those living in the South and Appalachia, including several states that did not expand Medicaid under the Affordable Care Act.² CDC updates diabetes data approximately every 2 years. The report released on July 18, 2017, includes data as of 2015 and shows that 30.3 million Americans, or 9.4% of the population, had diabetes, including T2D and type 1 diabetes (T1D).

The good news is that the rate of increase seems to be slowing, Ann Albright, PhD, RD, director of the CDC’s Division of Diabetes Translation, stated. “Diabetes is a contributing factor to so many other serious health conditions,” said Albright, who has made it a priority to find people with prediabetes, a condition that leads to T2D if left untreated.³

The CDC report predicts there are 84.1 million prediabetic individuals, which is about 2 million less than previous estimates.4 Working with the American Medical Association, Albright has made prediabetes the focus of a massive public health campaign. The CDC created the curriculum and recognition process for the National Diabetes Prevention Program (DPP), which Medicare will offer seniors with prediabetes in April 2018.5 Medicare has estimated that diabetes accounts for $1 of every $3 it spends; thus, reversing trends in diabetes is crucial if Medicare is to stay solvent in the decades ahead.⁶

Key findings from the CDC report include:

• In 2015, approximately 1.5 adults received a new diagnosis of diabetes (aged 18 or older).

• Nearly 1 in 4 adults with diabetes (7.2 million people) didn’t know they had the disease. Only 11.6% of adults with prediabetes knew they had it.

• The odds of being diagnosed with diabetes increases with age. Four percent of adults aged 18 to 44 years had diabetes, but that number jumps to 17% for those aged 45 to 65 years and to 25% for those 65 years or older. • One if 4 Americans eligible for Medicare has been diagnosed with diabetes, although the actual number is believed to be higher.¹

The report highlights significant disparities among those with diabetes and prediabetes, including:

• Native Americans and Alaska Natives had the highest rates of diabetes, at 15.1% of the population, followed by African Americans at 12.7% and Hispanics at 12.1%. By comparison, 8% of Asians and 7.4% of whites had diabetes.

• Adults with less education are more likely to have diabetes. Rates by level of education were: less than a high school diploma, 12.6%; high school education, 9.5%; some postsecondary education, 7.2%.

Rates of prediabetes were higher among men (36.6%) than women (29.3%); this split held up across education levels and ethnic groups. The higher rate among men has frustrated those offering the DPP because thus far, the majority of program enrollees have been women. Virtual programs, seen as a way to engage more men, were not fully included in the Medicare DPP under a rule proposed last week.

While the rate of new diagnoses might be slowing, better treatment methods and an aging population mean people can live many more years with the disease. This accounts for projections that a third of the population could be living with diabetes by midcentury, which public health officials say is unsustainable.

Besides the complications associated with diabetes itself, such as retinopathy and amputations, there is growing evidence of links between diabetes and Alzheimer’s disease—one of the costliest burdens in Medicare and Medicaid.

The common thread of insulin resistance runs through both conditions, and preventing T2D is now seen as a way of stopping as least some cases of Alzheimer’s. Right now, 5.5 million people have Alzheimer’s disease, and that number is projected to grow to 13.8 million by 2050.⁷

Gallup—Sharecare Survey Finds 11.6% of US Adults Have Diabetes, Tops CDC Study

The diabetes rate reached 11.6% among US adults in 2016 according to the results of a survey of 177,000 adults from Gallup and Sharecare. That rate, reported July 25, 2017, exceeds the 9.4% rate that CDC reported the same month, based on 2015 data culled from several sources.^1,2

The survey figure climbed from 10.6% in 2008, which means approximately 2.5 million more people have diabetes now than if the rate had remained steady, Dan Witters, research director of the Gallup—Sharecare Well-Being Index, told Evidence-Based Diabetes Management™ (EBDM™).

According to a report on the survey, it simply asks, “Has a doctor or nurse ever told you that you have diabetes?” It does not distinguish between types 1 and 2 diabetes; if anything, survey administrators wonder if this method may miss people who know they take medication for “blood sugar” but don’t realize they have type 2 diabetes. While Gallup—Sharecare and the CDC each have their own methods of calculating US diabetes prevalence, including different data sets and different ways of weighting them, Witters said they share this bottom line about diabetes: “It continues to grow, and it continues to grow in a way that’s pretty alarming.”

Gallup—Sharecare and the CDC agree on several points: The likelihood of diabetes rises as education and income fall, and rates are highest in the South and Appalachia, where people are comparatively poor and less educated. Historically, residents there have had less access to healthcare, as well; while some states—including Kentucky, West Virginia, and, recently Louisiana— expanded Medicaid under the Affordable Care Act, most states in this region have not.³

The ongoing rise in diabetes is not a surprise, given the continued increase in obesity, Witters said: “Until obesity slows, diabetes is going to continue to go up. It can’t help but go up.” He said that from 2010 to 2013, it appeared that obesity was leveling off, and so was the diabetes rate. “But over the past 3 years or so, [obesity] is pushing its way back up again,” he said. “I am personally not optimistic that this is flattening out.” The reason: Obesity continues to increase among people in their prime working years.

Some Occupations Hit Harder Than Others A key feature of the Gallup—Sharecare study is the analysis by occupation. Workers overall are younger and healthier, and this is seen in a diabetes rate of 6.9%, compared with the 23.9% for people aged 65 and older. But transportation workers—a category that includes long-haul truck drivers—have a rate of 10.3%, compared with physicians, who have the lowest rate (5.1%).

It’s easy to understand why truckers are at risk—they sit all day, and many eat lots of fast food. But farmers and forestry workers? According to the results, the rate of 8.5% for farmers and forestry workers reflects their age, which doesn’t offset their activity level. Smoking and drinking, which are more common among some types of workers than others, can offset the positive effects of physical activity.

What can employers do? “We have to take diabetes education outside the walls of the hospital,” Sheila Holcomb, vice president of Sharecare Diabetes Solutions (formerly Healthways) said during an interview with EBDM™.

Case Studies Show Effects of Benefit Design An ongoing, longtime project in Florida, featured in the survey report, reveals how changes in benefit design—which require higher out-of-pocket costs for people with diabetes—affect outcomes and may cause employers to rethink cost-sharing arrangements for people with diabetes. Munroe Regional Medical Center, in Ocala, along with insurer Florida Blue, organized diabetes education for a group of school district employees with the disease. Classes took place at times that did not conflict with school hours, and participants received testing supplies and medication, including insulin, at no charge.

Factoring in the cost of free supplies and drugs, the group had a 9% decrease in total healthcare costs, compared with a 39% increase for a second group that did not take part in the program. “Today, after 10 years, 47% of the participants remain active in the program and receive annual screening, program benefits, and 2 hours of follow-up education,” the report states.

These results show the importance of lifelong diabetes education—which is the policy position of the American Diabetes Association and the American Association of Diabetes Educators—Holcomb said.4 While coverage for education is better than it was 10 years ago, current benefit designs make co-pays too high for some. “Things will change. Medications will change,” she said. “Patients need to have the opportunity to change through their life span.”

References, CDC Report

1. National Diabetes Statistics Report, 2017. CDC website. cdc.gov/diabetes/pdfs/data/statistics/national-diabetesstatistics-report.pdf. Published and accessed July 18, 2017.

2. Current status of state Medicaid expansion decisions. Kaiser Family Foundation website. kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/. Updated January 1, 2017. Accessed July 23, 2017.

3. New CDC report: more than 100 million Americans have diabetes or prediabetes [press release]. Atlanta, GA: CDC; July 18, 2017. cdc.gov/media/releases/2017/p0718-diabetes-report.html. Accessed July 23, 2017.

4. Albright A. Prevention of type 2 diabetes requires both intensive lifestyle interventions and population-wide approaches. Am J Manag Care. 2015;21(suppl 7):SP238-239.

5. Proposed policies for the Medicare Diabetes Prevention Program expanded model in the calendar year 2018. Physician Fee Schedule proposed rule [press release]. Washington, DC: CMS; July 13, 2017. cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-07-13-2.html. Accessed July 14, 2017.

6. American Diabetes Association. Economic costs of diabetes in the United States. Diabetes Care. 2013;36(4):1033-1046. doi: 10.2337/dc12-2625.

7. 2016 Alzheimer’s disease facts and figures. Alzheimer’s Association website. alz.org/documents_custom/2016-factsand-figures.pdf. Accessed July 23, 2017.

References, Gallup-Sharecare

1. Gallup—Sharecare Well-Being Index. New diabetes research from Gallup and Sharecare. Sharecare website. wellbeingindex.com/face-of-diabetes. Published July 25, 2017. Accessed August 8, 2017.

2. Centers for Disease Control and Prevention. National diabetes statistics report, 2017. CDC website. cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published July 18, 2017. Accessed July 18, 2017.

3. The Henry J. Kaiser Family Foundation. Current status of state Medicaid expansion decisions. Kaiser Family Foundation website. kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision. Updated January 1, 2017. Accessed July 23, 2017.

4. Powers MA, Bardsley J, Cypress M, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care. 2015;38(7):1372-1382. doi: 10.2337/dc15-0730.

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