The Burden of Diabetes

1

2

Prevalence of Diabetes and Prediabetes in the United States

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

Prediabetes

37% of US population

Diabetes

9.1% of US population

2007 2011 20140

20

40

60

80

100

120

140

57

79 86

17.9

18.821.0

5.7

78.1

Undiagnosed DMDiagnosed DMPrediabetes

Pe

rso

ns

(m

illi

on

s)

1 2 3

3

1990 2000 2010 2020 2030 2040 20500

20

40

60

80

100

120

6.6 12 2137.9

55.571.2

86.6

7

12.7

13.1

13.3

13.7

UndiagnosedDiagnosed

Nu

mb

er

(mil

lio

ns

)

Projected Prevalence of Diabetes in the United States: 1990 to

2050

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.

Year

1 1 2 3 3 3 3

4

Prevalence of Diagnosed Diabetes in Different US Ethnic

and Racial Groups

CDC. National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

Non-Hispanic White

Asian Amer-ican

Hispanic Non-Hispanic Black

Native Amer-ican

0

2

4

6

8

10

12

14

16

18

7.69.0

12.8 13.2

15.9

Chart Title

Po

pu

lati

on

(%

)

US Adults ≥20 Years of Age

5

Annual Incidence of Diabetes in US Children and Adolescents

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

<10 years 10-19 years

All NHW NHB H API AIAN* All NHW NHB H API AIAN*0

10

20

30

40

50

Type 1 Type 2

Rat

e (p

er

100

,00

0 p

er y

ear)

6

T2D Prevalence ParallelsPrevalence of Obesity

1980 1994 2000 2008 2010 20120

10

20

30

40

50

60

70

BMI, body mass index (in kg/m2); 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.

1980 1994* 2000 2008 2010 20110

2

4

6

8

10

12

White men

White women

Black men

Black women

Mexican American men

Mexican American women

ObeseNHANES Data,

U.S. Adults ≥20 Years

Diagnosed DiabetesCDC Data,

U.S. Population

Po

pu

lati

on

(%

)

Increase in Diabetes Parallels the Increase in Obesity in the United States

7

*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.

Obesity* Diabetes

1998 20120

9

18

27

36

45

17.9

35.1

Po

pu

lati

on

(%

)

96% increase

1998 20140

2

4

6

8

10

12

6.5

9.3

43% increase

Popu

lati

on

(%

)

8

• 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

Diabetes Morbidity and Mortality

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.

9

Diabetes and Morbidity and Mortality

Stroke

Myocardial infarction

CVD death

All-cause death

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2

1.5

1.8

1.7

1.5

Risk increase(relative to individuals without diabetes)

CDC. National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

10

Costs of Diabetes

Diagnosed Undiagnosed Prediabetes Total*0

50

100

150

200

250

300

350

$176

$23$44

$244

$69

$9

$78

Indirect

Direct

US

Do

llars

(b

illio

ns

)

*Includes $1.3 billion in costs from gestational diabetes.

Dall TM, et al. Diabetes Care. 2014;37:3172-3179.

2012 Burden Estimate

11

Goal Achievement in Diabetes

*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.

NHANES 2007-2010*

0

10

20

30

40

50

60

70

80

90

100

52.2

27.5

79.1

56.851.3

77.7

14.3

72

51.4

12.6

Pa

tie

nts

wit

h d

iab

ete

s (

%)

<7 <8 >9 <70 <100

A1C(%)

LDL-C(mg/dL)

BP(mm/Hg)

<130/80

Nonsmoker All goals met Takinga statin

BP(mm/Hg)

<140/90

N=1444 N=1342

12

A1C Achievement by Individualized Target

NHANES, National Health and Nutrition Examination Survey.

Ali MK, et al. N Engl J Med. 2013;368:1613-1624.

NHANES 2007-2010(N=1444)

Age (years) 18-44 45-64 ≥65 ≥65 18-44 45-64 ≥65

Target A1C (%) ≤6.5 ≤7.0 ≤7.0 ≤7.5 ≤7.0 ≤8.0 ≤8.0

Without complications With complications

0

10

20

30

40

50

60

70

80

90

100

37.0

52.057.1

69.4

39.4

57.1

74.6

Pa

tie

nts

wit

h d

iab

ete

s (

%)