Longer lives for diabetics come with ‘high price tag’ for healthcare system

Older diabetic patients are living longer as they and their physicians get better at managing the condition, but with longer lifespans comes additional years of much higher healthcare expenditures.

“The fact that higher diabetes prevalence trends are now being driven by longer lifespans, rather than new cases, is an unqualified victory for public health. But this victory comes with a high price tag—particularly for older Americans,” Jeroen van Meijgaard, PhD, a researcher at the UCLA Fielding School of Public Health, wrote in a report.

The prevalence rate for diabetes reached nearly 10 percent in 2015, according to data from the Centers for Disease Control and Prevention (CDC). The incidence rate, however, has been on the decline since 2008, falling from 8.7 new cases per 1,000 people to 6.7 new cases per 1,000 people in 2015—which is still much higher than its rate in 1990.

Diabetes-related mortality hasn’t changed much between 1999 and 2015, van Meijgaard wrote. His calculation of the case mortality rate—the number of deaths where diabetes was a contributing factor versus the number of diabetics in a given year—told a different story, showing the added mortality risk of diabetes has declined.

Diabetics are now living a mean of 13.1 years with the disease, up from 10.8 years in 1997. That means additional years these patients are spending money managing the disease, requiring frequent checkups, monitoring and medications. With the American Diabetes Association estimating annual healthcare expenditures attributable to diabetes at $7,888 per patient, lifetime spending can “easily exceed $100,000” for a single patient.

This will mean greatly increased spending on diabetes-related medical costs for Medicare, van Meijgaard wrote, reaching $142 billion (in 2017 dollars) by 2030.

“A large percentage of the population is pre-diabetic, having elevated blood sugars, but not high enough to be diagnosed as diabetic," he wrote. “Early detection of pre-diabetes through screening can help patients make the necessary changes to their lifestyle and behavior to avoid becoming diabetic. Health departments typically have limited resources, but will nevertheless need to step up efforts to prevent the progression from pre-diabetes to diabetes in the population—while simultaneously addressing the increased cost of treatment of the existing diabetes population.”