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The number of Americans being diagnosed with and also living with type 2 diabetes is soaring, presenting a major health and economic crisis for the United States, a new study reports.
"What's alarming is we have 47 million uninsured people, but these people [in the study, enrolled under Medicare] are all insured. So in this kind of insured program, we have so many people who are not adhering to the recommended care," said Frank Sloan, lead author of the study published in the Jan. 28 issue of theArchives of Internal Medicine.
Sloan is professor of health policy and management at Duke University Medical Center in Durham, N.C.
The prevalence of type 2 diabetes is increasing not only in an aging population, but in younger persons as well. The condition brings with it high risks of complications such as blindness, kidney disease, eye disease and amputations.
To see whether health outcomes in older people with diabetes in the United States improved from the period 1994 to 2004, the study authors analyzed Medicare claims and other data. This information was compared with two "control" groups of people without diabetes.
Between 1994-95 and 2003-04, the annual incidence of diabetes (new diagnoses) increased by 23 percent, while the prevalence (those living with the disease) increased by 62 percent.
Complication rates among people with diabetes stayed the same or increased. Strikingly, there was a large increase in kidney disease.
Most individuals with diabetes had at least one complication within six years of diagnosis. Almost half had congestive heart failure.
The study points to a stark need for preventive strategies, said Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City.
"What we're doing is treating, and we're not treating the problem at the beginning," he said. "Already one-third of the budget for Medicare is for diabetes. This is an epidemic, and we're not doing much to prevent it, and we're not doing very well controlling it. It's going to get worse before it gets better."
Jane Bolin, associate professor of health policy and management at Texas A&M Health Science Center School of Rural Public Health in College Station, added: "It starts back at prevention and has to do with healthier lifestyles and teaching people how to monitor themselves. Right now, self-management is not reimbursable [by Medicare] unless done under certain conditions, and it puts a hardship on a lot of patients. I think we're becoming better at diagnosing and dealing with complications, but we need to move back further to prevention."
An estimated 19 million to 20 million Americans have type 2 diabetes, and about one-third of them don't even know they have the disease. It is characterized by high levels of blood sugar that are caused by the body's inability to process the hormone insulin to transport blood sugar to cells for energy.
Another study in the same issue of the journal questions how accurate Medicare data is in reflecting the health and health needs of the U.S. population.
Clinical trials used by Medicare to make decisions about coverage include participants who are not representative of the actual Medicare population, said the study authors, from the University of California, San Francisco, School of Medicine.
Trial participants tended to be younger, male and living in countries outside the United States, the researchers said.
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