Scope of the Problem: Diabetes if the 5th leading cause of death in the U.S,
over 200,000 Americans die of complications from
diabetes each year. 18 million Americans had diabetes in 2002 6.2% of
the total U.S. population. 1 This number is expected to double by 2050. 5.2 million of those with diabetes do not know they
have it. 2 An additional 16 million adults aged 4074 have
prediabetes (their blood sugar level is elevated but does
not meet the criteria for diabetes). Many of these
people will develop diabetes. 3 The number of people with diabetes in the US has
increased 61% since 1991. 4 Research suggests that diabetes could increase 165% by
2050. 5 Patients at higher risk for diabetes include those who
are overweight, have a strong family history of diabetes
or have a racial or ethnic background associated with
an increased risk. Diabetes can cause heart disease, stroke, blindness,
kidney failure, pregnancy complications, amputations
and deaths related to flu and pneumonia. Racial/ethnic minority groups are disproportionately
affected by both the prevalence of diabetes, the
prevalence of diabetes complications (such as renal
disease) and higher mortality rates. Costs: The U.S. Health system spent $132 billion in 2002 on
direct (medical care) and indirect (disability and death)
costs from adults with type 2 diabetes. Costs related to diabetes represented 11% of national
healthcare expenditures in 2002. 6 The average yearly healthcare cost for a person with
diabetes was $13,243 in 2002. The healthcare cost for
a person without diabetes averages $2,560. 7 Disability as a Result of Diabetes: Each year in the US:
12,00024,000 people become blind as a result of
diabetic eye disease. 8 42,813 people with diabetes are diagnosed with kidney
failure, and over 100,000 are treated for this
condition. 9 82,000 diabetics undergo leg, foot or toe amputations. Actionable Strategies for Employers: Although routine screening among adults is not
explicitly recommended by the USPSTF, preventing
the onset of diabetes is vital to manage this disease
among the workforce.
Ensure that health plans are adequately screening
at-risk patients for this condition and providing
appropriate patient education, disease management
programs and follow-up care Diabetes education
and disease management programs have been proven
to reduce diabetes related complications. For example,
foot care programs that include regular examinations
and patient education can prevent up to 85% of
diabetes related amputations (CDC, 2004). Workplace health promotion for exercise, healthy
diets, smoking cessation and healthy weights all
factors in reducing the chance of developing
diabetes This is especially important for individuals
already with diagnosed diabetes, those with an
increased risk for cardiovascular disease and individuals
with impaired glucose tolerance or impaired fasting
glucose levels (possible precursors to type 2 diabetes). Ensure that health promotion is culturally
competent In worksite programs, provide materials
that are racially/ethnically representative. Consider screening high-risk employees at on-site
health risk assessments. Additional Resources: USPSTF Recommendations for diabetes
http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm American Diabetes Association www.diabetes.org CDC: Diabetes http://www.cdc.gov/diabetes/
index.htm U.S. Preventive Services
Task Force Screening
Recommendations The USPSTF recommends screening for type 2 diabetes in adults with hypertension (chronic high
blood pressure) or hyperlipidemia (high fat and
cholesterol levels in the blood). (B) The USPSTF found insufficient evidence to recommend for or against routinely screening adults without
symptoms for type 2 diabetes, impaired glucose
tolerance, or impaired fasting glucose (possible
precursors to diabetes). (I) The decision to screen individual patients is a matter of clinical judgment. Patients at high risk for
cardiovascular disease may benefit most from
screening. Regardless of whether the clinician and patient decide to screen for diabetes, patients should be encouraged
to exercise, eat a healthy diet, and maintain a healthy
weight. 27 DIABETES MELLITUS, TYPE 2 A condition where there is too much glucose (sugar) in the blood and urine due to an inadequate supply of insulin or insensitivity to insulin. 1 CDC Diabetes Surveillance Report 2002. http://www.cdc.gov/diabetes/pubs/factsheet.htm; 2, 3, 4, 6, 7, 8, 9 CDC (2004). Diabetes: Disabling, Deadly, and on the Rise. http://www.cdc.gov/nccdphp/aag/aag_ddt.htm. Accessed 10-25-04; 5 Boyle, Diabetes Care. 2001.