Diabetes mellitus (“Diabetes”) is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

There are 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease. Diabetes can be associated with serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform.

With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.

In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.

Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes.  Type 1 diabetes is a result of the body’s failure to produce insulin, it develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors for type 1 diabetes may include autoimmune, genetic, and environmental factors.

• According to the American Diabetes Association, the total annual economic cost of diabetes in 2007 was estimated to be $174 billion.  Medical expenditures totaled $116 billion and were comprised of $27 billion for diabetes care, $58 billion for chronic diabetes-related complications, and $31 billion for excess general medical costs. Indirect costs resulting from increased absenteeism, reduced productivity, disease-related unemployment disability, and loss of productive capacity due to early mortality totaled $58 billion.  This is an increase of $42 billion since 2002. This 32% increase means the dollar amount has risen over $8 billion more each year.

• The 2007 per capita annual costs of health care for people with diabetes is $11,744 a year, of which $6,649 (57%) is attributed to diabetes.

• One out of every five health care dollars is spent caring for someone with diagnosed diabetes, while one in ten health care dollars is attributed to diabetes.

• Estimated at $116 billion, including $27 billion for care to directly treat diabetes, $58 billion to treat diabetes-related chronic complications, and $31 billion in excess general medical costs.

• People with diagnosed diabetes, on average, have medical expenditures that are approximately 2.3 times higher than those without diabetes. Diagnosed diabetes patients account for 5.8 percent of the total U.S. population. 

• $58.3 billion was spent on inpatient hospital care and $9.9 billion on physician’s office visits directly attributed to diabetes.

• Diabetes-related hospitalizations totaled 24.3 million days in 2007, an increase of 7.4 million from the 16.9 million days in 2002. The average cost for a hospital inpatient day due to diabetes is $1,853 and $2,281 due to diabetes-related chronic complications, including neurological, peripheral vascular, cardiovascular, renal, metabolic, and ophthalmic complications.  

• Estimated to be $58 billion in 2007.

• In 2007, diabetes accounted for 15 million work days absent, 120 million work days with reduced performance, 6 million reduced productivity days for those not in the workforce, and an additional 107 million work days lost due to unemployment disability attributed to diabetes.

• Diabetes caused 445,000 cases of unemployment disability in 2007.

• 284,000 deaths were attributed to diabetes in 2007.  The value of lost productivity due to premature death is $26.9 billion. 
• People with diabetes, on average miss 1.9 more days per year than their peers who do not have diabetes. 

• The increase in the cost of diabetes reflects three causes:
  • the growth in diabetes prevalence;
  • medical costs rising faster than general inflation; and
  • improvements made in the methods and data sources influencing cost estimates.
• The actual national burden of diabetes likely exceeds the $174 billion estimate because it omits the social cost of intangibles such as pain and suffering, care provided by non-paid caregivers, excess medical costs associated with undiagnosed diabetes, and diabetes-attributed costs for health care expenditures categories not studied. 
• According to CDC, in 2005 20.8 million Americans had diabetes, with nearly a third undiagnosed.  Another 54 million have pre-diabetes, and are likely to have the disease if they do not alter their living habits.  The percent of the population with diagnosed diabetes continues to rise.  Rates have risen from 2.5% in 1980, to 4.2% in 2002, to 5.8% in 2007, and are estimated to rise to 12% by 2050.  Many factors contribute to this rise, including higher prevalence of overweight and obesity, changes in diagnostic criteria, improved or enhanced detection, decreasing mortality, a growing elderly population, and growth in minority populations in whom the prevalence and incidence of diabetes are increasing.

• 1.3 Million adult Americans (aged 20 years or older) are diagnosed with diabetes each year.
• Diabetes is the 6^th leading cause of death listed on the US death certificates where diabetes is listed as an underlying cause.
• Diabetes is likely to be under reported as a cause of death because many decedents with diabetes do not have the disease entered on their death certificate.