Diabetes: what lies ahead?

May 18, 2014

The lead article in this issue’s Continuing Education section—“Diabetes: the past, the present, and the challenging future” by Nancy Haley, PhD, and Martu
Richards—paints a grim picture of a near future in which an epidemic of type 2 diabetes has a profound impact on the social and economic life of the United States. Haley and Richards provide sobering statistics both on diabetes and its association with obesity and heart disease. I quote from the article: 

In the U.S., the number of people diagnosed with diabetes has risen from 1.5 million in 1958 to 25.8 million in 2011, an increase that is epidemic in proportion.…One of the most disturbing increases in type 2 diabetes is seen in youth. Prior to 1980, this disease was rarely seen in children, but 3,600 cases a year were seen between 2002 and 2005.

The impact of obesity on developing diabetes has been demonstrated….A female who is classified as obese at 18 years of age has more than a 50% risk of developing diabetes over her lifetime. This risk jumps to more than 75% in a female classified as very obese.

Compared to the general population, people living with diabetes have death rates from heart disease and stroke that are two to four times higher. ….Deaths from heart disease in women with diabetes have increased 23% over the past 30 years, compared to a 27% decrease in women without diabetes.

Significantly, the authors also speak of the financial costs of diabetes: 

The CDC estimates the cost of diabetes in the U.S. was $194 billion in 2011 and will increase to more than $250 billion in 2014. This is unsustainable, with many predictions that the epidemic will impact one out of three Americans by mid-century. Diabetes treatment, including medications and monitoring supplies, costs each patient about $11,700 annually. If he or she develops one diabetic complication, such as retinopathy, the individual cost rises to an average of $20,700 per year.

In her accompanying article, “HbA1c for the diagnosis of diabetes,” author Ranka Milojkovic also alludes to the “staggering financial and human costs” of the disease.

To my mind, all of this suggests that in the years ahead, not only will virtually all Americans know someone with diabetes—that is probably already true—but they will know someone with diabetes well—a relative, friend, or maybe that face they look at in the mirror each morning. Also, whatever shape healthcare reform takes in the U.S. in the coming decades, diabetes care will place a major burden on the economy.

These dire predictions are not unalterable. Public education and research into diagnostics and treatment can have a positive effect. So might screening the general population, an option both Haley and Richards and Milojkovic suggest.

So might something that was in the news last month: the decision by an FDA advisory panel to approve Afrezza, an inhalable insulin produced by MannKind Corporation, for clinical trials. The FDA as a whole may or may not follow the recommendation (the agency has announced it will make a decision by July 15), and we remember that hopes were raised and later dashed by Pfizer’s Exubera a few years ago. But if safe, inhalable insulin becomes a reality in the years ahead, that would likely have a positive effect on patient compliance.  

It might make more people more willing to be tested for diabetes, too: I have a hunch that the fear of the prospect of self-injection may be one thing that, however irrationally, keeps some “diabetes deniers” from seeking to find out, via glucose or HbA1c testing, whether they have the disease.