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 (
%)
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