What the Diabetes Health Economy Looks Like in 2024

The US health care system remains the most expensive in the world, largely funded by the federal government, state Medicaid programs, and employers. In just a decade, national health spending rose from $2.8 trillion in 2012 to $4.5 trillion in 2022, even though demand and utilization remained relatively steady.¹

In just a decade, national health spending rose from $2.8 trillion to $4.5 trillion | Image credit: Keattipoom – stock.adobe.com

According to projections published in Trilliant Health’s 2024 Trends Shaping the Health Economy report, health care spending could reach $7.7 trillion by 2032.

In an interview with The American Journal of Managed Care^® (AJMC^®), Sanjula Jain, PhD, chief research officer at Trilliant Health, explained how the report doesn’t just look at the health care economy in a moment in time, but rather helps contextualize new, ongoing, and accelerated trends.

“When you see demand against the backdrop of supply, what's interesting is that price should go down, but that actually has not happened in our history of health care,” Jain told AJMC. “I don't think anybody would argue [against] that American health care is expensive, right? This idea that we have these inflated costs or price relative to our supply and demand dynamics just hasn't added up for years, and we call that into question.”

The report highlighted 8 key macro trends shaping the US health economy in 2024:

• The US health care system is both inefficient in promoting health and disproportionately costly
• Patterns of health care usage indicate the nation's health is likely to keep deteriorating
• Government efforts in innovation and regulation are failing to deliver real value
• The impact of technological progress in health care remains unclear and unpredictable
• Resource shortages are linked to suboptimal outcomes in health care delivery
• Shifting costs to consumers has led to fragmented care without delivering proportional value
• Care provided in lower-cost settings may offer improved value and outcomes
• Employers are in a stronger position to demand better value for their health care spending

These broader trends set the stage for a closer look at specific health challenges highlighted in the report, particularly the evolving landscape of diabetes care and the impact of new treatment options on both patients and the health care system.

Diabetes Prevalence in the US

As of 2022, approximately 8.4% of adults in the US live with diagnosed diabetes, a 6% increase since 2000.²

“Americans have higher rates of obesity and diabetes and more behavioral health conditions today than ever before,” the report said, noting that the average US life expectancy is just slightly higher than it was in the year 2000 and is still lower than several other countries.¹

Diabetes was among the top 5 reasons for home health visits between 2019 and 2023, with type 1 diabetes accounting for 3.7% of all home visits and type 2 diabetes accounting for 3.6% among commercially insured patients. For reference, postpartum care was the number 1 reason by a landslide at 8.6%.

While the overall volume of patients utilizing home health dropped by 5.4% over those 4 years, chronic conditions like diabetes, asthma, chronic obstructive pulmonary disease, and rheumatic conditions still make up a substantial share of home health care. Additionally, the percentage of American adults with chronic conditions is projected to increase by 12.4% by 2050, expected to affect more than 220 million adults.

This can be largely attributed to the growing aging population in the US. Research suggests the number of Americans 50 years and older will increase by 61.11% between 2020 and 2050; of this population, the number of older adults with at least 1 chronic condition is projected to double from approximately 71.5 million to 142.6 million in just the next 30 years.³

How Does Obesity Play Into These Trends?

Obesity has steadily risen in prevalence both nationally and regionally from 2011 to 2022.¹ The South and Midwest regions consistently had the highest obesity prevalence, reaching 36% by 2022, while the national average stood just above 33%. The West and Northeast, although showing the lowest obesity rates, still experienced a significant upward trend, climbing from around 25% in 2011 to more than 30% in 2022. These findings highlight the persistent challenge of obesity across the country, with regional variations pointing to differing health care needs and outcomes.

A major contributor to this trend is the fact that Americans are eating more and more ultraprocessed foods, leading to an increase in the percentage of total energy intake from these foods. Starting at 53.5% in 2001—which was already high—the proportion of energy derived from these foods increased steadily over the years, reaching 57% by 2018. While similar trends can be seen in the United Kingdom, these numbers are much higher than in countries like Italy (10%) and others that better follow a Mediterranean diet.⁴

This ultraprocessed diet is not just affecting adults either. In a prior interview, Robert Lustig, MD, MSL, endocrinologist and professor emeritus of pediatrics at the University of California, San Francisco, talked to AJMC about the impact of diet early in life and its long-term effects.⁵

“First of all, you have to understand that obesity is not the problem, obesity is a marker for the problem,” Lustig told AJMC. “Metabolic dysfunction is the problem and 93% of Americans today have metabolic dysfunction, and that includes children.”

From 1963 to 2018, the percentage of American children and adolescents with obesity jumped from less than 5% to more than 20%.⁶ According to Lustig, sugar is a primary environmental and dietary factor contributing to metabolic dysfunction and related diseases like type 2 diabetes and fatty liver disease in children. Some of the main culprits include cereals and fruit juice, but children are being exposed to unhealthy food even earlier in life.

“It's a big problem keeping kids away from sugar, since it's in everything, including baby food,” Lustig said.

These challenges point to the urgent need for strategies that target both prevention and treatment, particularly when it comes to improving metabolic health across all age groups.

The Clinical Value of Diabetes Medications

The average number of diabetes medications per patient rose from 1.58 in 2018, to 1.65 in 2023.¹ During the same time period, glucagon-like peptide 1 (GLP-1) receptor agonists went from being the eighth most common drug regimen to the second most common. The increase in prescriptions was clear in the report, as GLP-1 drugs went from making up just 4.4% of type 2 diabetes drugs prescribed early in 2018, to 19.8% by the end of 2023.

Metformin has remained the most common medication for managing type 2 diabetes, but amid the rising popularity of GLP-1 receptor agonists, insulin went from the second to third most commonly prescribed diabetes management drug.

The surge in GLP-1 prescriptions reflects a broader shift in the landscape of diabetes care, as newer therapies gain traction due to their potential to address not only blood sugar control but also weight management. However, just because a patient begins taking a GLP-1 drug doesn’t mean they no longer need to take metformin or insulin, and polypharmacy is still common. This rise in medication use brings up important questions about the balance between clinical benefit and cost.

“On average, diabetes patients are still taking more drugs today than they were before, so when it comes back to value, we have to weigh the clinical value against the costs,” Jain told AJMC. “Patients being on more drugs is not necessarily a high value kind of proposition. But if we had seen a decline in the average number of prescriptions that a diabetes patient was taking, that might be a slightly different conversation.”

As health care stakeholders navigate these complexities, it’s important to ensure that advancements in treatment truly translate into better health outcomes for patients with diabetes, rather than just adding to the financial burden of managing diabetes.

References

1. 2024 trends shaping the health economy: macro edition. Trilliant Health. October 1, 2024. Accessed October 1, 2024. https://www.trillianthealth.com/market-research/reports/2024-health-economy-trends
2. Elfein J. Number of U.S. Americans with diagnosed diabetes from 1980 to 2022. Statista. May 22, 2024. Accessed September 30, 2024. https://www.statista.com/statistics/240883/number-of-diabetes-diagnosis-in-the-united-states/
3. Ansah JP, Chiu CT. Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Front Public Health. 2023;10:1082183. doi:10.3389/fpubh.2022.1082183
4. Marino M, Puppo F, Del Bo' C, et al. A systematic review of worldwide consumption of ultra-processed foods: findings and criticisms. Nutrients. 2021;13(8):2778. doi:10.3390/nu13082778
5. Klein HE. Dr Robert Lustig on pediatric metabolic health: “sugar is the alcohol of the child”. AJMC. June 21, 2024. Accessed September 30, 2024. https://www.ajmc.com/view/dr-robert-lustig-on-pediatric-metabolic-health-sugar-is-the-alcohol-of-the-child-
6. Klein HE. How can we improve obesity care in 2024 and beyond? Am J Manag Care. 2024;30(Spec No. 10):SP766-SP770. doi:10.37765/ajmc.2024.89611