Transcript The Burden of Diabetes Prevalence of Diabetes and Prediabetes in the United States Persons (millions) Undiagnosed DM Diagnosed DM Prediabetes 8.1 21.0 18.860 Diabetes 9.1% of US population 5.7 17.9 Prediabetes 37% of US.

The Burden of Diabetes
1
Prevalence of Diabetes and
Prediabetes in the United States
140
Persons (millions)
120
Undiagnosed DM
Diagnosed DM
Prediabetes
8.1
7
100
21.0
18.8
80
60
Diabetes
9.1% of US population
5.7
17.9
40
79
86
20112
20143
Prediabetes
37% of US population
57
20
0
20071
1. CDC. National diabetes fact sheet, 2008. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2008.pdf.
2. CDC. National diabetes fact sheet, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
3. CDC. National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
2
Projected Prevalence of Diabetes
in the United States: 1990 to
2050
Undiagnosed
Diagnosed
Number (millions)
120
100
13.7
80
13.3
13.1
60
12.7
40
20
6.6
0
19901
37.9
12
7
21
20001
2010 2
20203
55.5
20303
71.2
20403
86.6
2050 3
Year
1. National Diabetes Surveillance System. http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm. 2. CDC. National diabetes
fact sheet, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 3. Boyle JP, et al. Popul Health Metr. 2010 Oct 22;8:29.
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Prevalence of Diagnosed
Diabetes in Different US Ethnic
and Racial Groups
US Adults ≥20 Years of Age
18
15.9
Population (%)
16
14
12.8
13.2
Hispanic
Non-Hispanic
Black
12
9.0
10
8
7.6
6
4
2
0
Non-Hispanic Asian American
White
CDC. National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
Native
American
4
Annual Incidence of Diabetes in
US Children and Adolescents
Rate (per 100,000 per year)
50
Type 1
40
Type 2
30
20
10
0
All
NHW
NHB
H
<10 years
API
AIAN*
All
NHW
NHB
H
API
AIAN*
10-19 years
AI, American Indians; API, Asians/Pacific Islanders; H, Hispanics; non-Hispanic blacks; NHW, non-Hispanic whites; NHB.
CDC. National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
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T2D Prevalence Parallels
Prevalence of Obesity
70
Obese
Diagnosed Diabetes
NHANES Data,
U.S. Adults ≥20 Years
CDC Data,
U.S. Population
Population (%)
60
12
10
50
White men
White women
8
40
Black men
6
Black women
30
4
20
10
2
0
0
1980 1994 2000 2008 2010 2012
Mexican American
men
Mexican American
women
1980 1994* 2000 2008 2010 2011
BMI, body mass index (in kg/m 2); CDC, Centers for Disease Control and Prevention; NHANES, National Health and Nutrition Examination
Survey (x-axis lists last year of each survey); T2D, type 2 diabetes.
*NHANES 1994 data.
Flegal KM, et al. Int J Obes Relat Metab Disord. 1998;22:39-47. Flegal KM, et al. JAMA. 2002 ;288:1723-1727. Flegal KM, et al. JAMA.
2010;303:235-241. Flegal KM, et al. JAMA. 2012;307:491-497. Ogden CL, et al. JAMA. 2014;311:806-814. Harris MI, et al. Diabetes Care.
1998;21:518-524. CDC. Diabetes data & trends. Available at: http://www.cdc.gov/diabetes/statistics/prev/national/figraceethsex.htm and
http://www.cdc.gov/diabetes/statistics/prev/national/fighispanicthsex.htm.
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Increase in Diabetes Parallels the
Increase in Obesity in the United States
Obesity*
45
12
96% increase
Population (%)
27
18
17.9
9
43% increase
10
35.1
36
Population (%)
Diabetes
9.3
8
6.5
6
4
2
0
0
1998
2012
1998
2014
*BMI ≥30 kg/m2.
CDC. National diabetes statistics report, 2014. Atlanta, GA: US Department of Health and Human Services, Centers for Disease
Control and Prevention, 2014. Mokdad AH, et al. JAMA. 1999;282:1519-1522; Mokdad AH, et al. Diabetes Care. 2000;23:1278-1283;
Ogden CL, et al. JAMA. 2014;311:806-814.
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Diabetes Morbidity and Mortality
• 7th leading cause of
death in US
• Leading cause of
blindness
• Most frequent cause of
kidney failure
• ~60% of nontraumatic
lower limb amputations
occur in people with
diabetes
• Diabetes also
– Doubles the risk of
periodontal disease
– Doubles the risk of
developing depression
• Depression increases T2D
risk by 60%
– Increases patients’
susceptibility to acute illness
(eg, pneumonia and
influenza)
• Worsens the prognosis of
patients with acute illnesses
CDC. National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.
CDC. National diabetes fact sheet, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
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Diabetes and Morbidity and
Mortality
All-cause death
1.5
CVD death
1.7
Myocardial
infarction
1.8
Stroke
1.5
0
0.5
1
1.5
Risk increase
(relative to individuals without diabetes)
CDC. National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/nationaldiabetes-report-web.pdf
2
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Costs of Diabetes
2012 Burden Estimate
350
Indirect
US Dollars (billions)
300
Direct
$78
250
200
$69
150
$244
100
$176
50
0
Diagnosed
$9
$23
$44
Undiagnosed
Prediabetes
Total*
*Includes $1.3 billion in costs from gestational diabetes.
Dall TM, et al. Diabetes Care. 2014;37:3172-3179.
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Goal Achievement in Diabetes
NHANES 2007-2010*
N=1444
Patients with diabetes (%)
100
90
79.1
80
N=1342
77.7
72
70
56.8
60 52.2
50
51.4
51.3
40
27.5
30
20
14.3
12.6
10
0
<7
<8 >9
A1C
(%)
<70 <100
<130/80
LDL-C
(mg/dL)
BP
(mm/Hg)
<140/90
Nonsmoker All goals met
BP
(mm/Hg)
Taking
a statin
*Data from separate studies.
BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Survey.
Ali MK, et al. N Engl J Med. 2013;368:1613-1624. Stark Casagrande S, et al. Diabetes Care. 2013;36:2271-2279.
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A1C Achievement by
Individualized Target
Patients with diabetes (%)
NHANES 2007-2010
(N=1444)
100
90
80
70
60
50
40
30
20
10
0
Age (years)
Target A1C (%)
74.6
69.4
52.0
57.1
57.1
39.4
37.0
18-44
45-64
≥65
≥65
18-44
45-64
≥65
≤6.5
≤7.0
≤7.0
≤7.5
≤7.0
≤8.0
≤8.0
Without complications
With complications
NHANES, National Health and Nutrition Examination Survey.
Ali MK, et al. N Engl J Med. 2013;368:1613-1624.
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