Sunday, April 15, 2007

60% of People With Type 2 Diabetes Will Suffer Complications

Its no secret that the risk of complications is high with a chronic disease like diabetes, but the risk can usually be reduced with careful management. Some studies have suggested that in spite of far fewer patients living with the condition, complications for type 1 are as costly as they are for type 2, attributed to the fact that average age of diagnosis for patients with type 1 diabetes is 14 years, whereas the average age of diagnosis for patients with type 2 diabetes is 46 years. This means that while an average 60 year old with type 1 diabetes has lived with their condition for an average of 46 years, an average 60 year old with type 2 diabetes has lived with their condition for an average of only 14 years.

News from a study whose results were presented at the American Association of Clinical Endocrinologists (AACE) meeting in Seattle reported in Saturday's Los Angeles Times featured a very disturbing story. In spite of living with type 2 diabetes for a statistically significant shorter period of time than the average patient with type 1 diabetes, the incidence of complications among patients with type 2 diabetes is simply staggering. Notably, 3 out of every 5 patients with type 2 diabetes suffer from at least 1 significant complication of the disease. One out of every 10 has 2 complications, 1 out of 15 has 3 complications, and 1 out of 13 has 4+ complications. These sobering statistics were derived from the National Health and Nutrition Examination Survey (NHANES) report between 1999 and 2004 and combined with economic data from the Medical Expenditure Panel Survey (MEPS). The economic data came from the government's Medical Expenditure Panel Survey conducted during the same period. I should note, however, that the "complications" may be symptomatic of other co-morbidities associated with type 2 diabetes, not necessarily the condition itself. Still, the incidence suggest major issues for policymakers, especially at Medicare.

"We are using the tools [to control diabetes] too late, and spending too much money on complications," said Dr. Daniel Einhorn of the Sharp Diabetes Treatment and Research Center in San Diego in a teleconference releasing the findings.

"We knew that these complications were out there, but the sheer magnitude was a surprise," he said.

Aside from the human suffering exemplified by these statistics, the real danger is that type 2 diabetes is growing at an alarming (some say epidemic) rate and presents a unique challenge because unlike type 1 diabetes, the disease can be present for years without a diagnosis whereas the symptoms for type 1 develop very rapidly and are virtually impossible to ignore. Also, the challenges for patients to adjust to a new lifestyle required often make the adjustment much more difficult for many newly diagnosed type 2 patients. Even more troubling is the fact that the U.S. healthcare system is a model based primarily on treatment of acute illnesses, not chronic illnesses. This results in many patients struggling to obtain coverage for sufficient testing supplies, while complications such as dialysis resulting from nephropathy are automatically covered under Medicare.

As I noted in my posting earlier this week (see here), Pennsylvania recently took steps to address this issue, but we still have a long way to go before we are adequately prepared for the rapid growth in chronic diseases like diabetes.

Among other findings in the report:

  • Congestive heart failure occurs in 7.9% of diabetics, compared with 1.1% of people without the disease. It costs an average of $7,932 per year per patient.

  • Heart attacks occur in 9.8% of diabetics, compared with 1.8% of others. They cost patients $14,150 per year.

  • Coronary heart disease occurs in 9.1% of diabetics, compared with 2.1% of others. It costs patients $6,062 per year.

  • Strokes occur in 6.8% of diabetics, compared with 1.8% of others. They cost patients $7,806 per year.

  • Chronic kidney disease occurs in 27.8% of diabetics, compared with 6.1% of others. It costs patients $9,002 per year.

  • Foot problems, such as amputations and numbness, occur in 22.8% of diabetics, compared with 10% of others. They cost patients $4,687 per year.

  • Eye damage occurs in 18.9% of diabetics. Comparable figures are not available for nondiabetics. It costs patients $1,785 per year.


Kate said...

Thank you for posting this! So much of the time I think of diabetes as a silent killer because people don't realize that these kinds of complications happen, at the alarming rate that they do. And research in the last couple of years has also shown that there is the beginnings of microvascular complications (eye, kidney,nerve disease,etc) even in people with prediabetes- so I'm not too surprised at these numbers. Just saddened that our healthcare system has so many roadblocks to change them. Like not covering people with prediabetes getting nutrition teaching. It annoys me to no end.

Scott S said...

Thanks for your comment! You're right about the research on prediabetes, and the troubles people have getting coverage for nutrition training and the like. I hope Pennsylvania Governor Rendell is successful in changing coverage for chronic conditions like diabetes, that could change the situation dramatically!