While the burden of the costs of diabetes care cannot be refuted, policy-makers do not agree upon the sources of potential funding and strategies to address the burden. How much does diabetes cost us? In 2017, the estimated cost of diagnosed diabetes care was about $327 billion for America (ADA, 2018). About $237 billion of this is from direct medical costs; the remaining $90 billion is due to reduced productivity. About 67.3% of diabetes care in the U.S. is paid for my government insurances, such as Medicare, Medicaid, and the military. Only 2% of this cost is paid by the uninsured, and about 30.7% is paid for by private insurances. To sustain any kind of changes to reduce cost of care or improve care for individuals with pre-diabetes or diabetes, financial strategies will have to be considered carefully.
Ultimately, to save costs related to diabetes, strategies need to be aimed at prevention. Preventive measures could focus on healthy lifestyle modifications and alterations to environments of communities to facilitate these healthy behaviors. Specifically, we need to promote physical activity, weight loss, and increasing fiber intake (Bergman et al., 2012). Policies including strategies to educate the public and providers need to be developed to increase detection of at-risk individuals and appropriately refer them to programs that will intervene to promote healthy lifestyle modifications. Agricultural policies should not be discounted, as the agriculture and food industries have great influences on the health of our nation.
To promote the necessary changes for the prevention of diabetes, we must advocate for widespread health system changes, encourage funding and facilitation of evidence-based research, bring these issues on the agenda for policy-makers, and provide them with the evidence they need to support their case for the changes (Bergman et al., 2012). The only way changes will be sustainable is if they are aimed at prevention. Transitioning to a proactive system, focused on early detection and prevention, rather than continuing to be a reactive system, focused on medications and treatments, will be essential to reduce costs associated with the burden of diabetes in our nation.
American Diabetes Association. (2018). The cost of diabetes. Retrieved from https://www.diabetes.org/resources/statistics/cost-diabetes
Bergman, M., Buysschaert, M., Schwarz, P. E., Albright, A., Narayan, K. V., & Yach, D. (2012). Diabetes prevention: Global health policy and perspectives from the ground. Diabetes management, 2(4), 309–321. doi:10.2217/dmt.12.34
Expanding Financial Coverage for Education and Treatment of Pre-diabetes 
$327 BILLION?! That is a lot of money spent on a chronic disease. My DNP project was on heart failure hospital readmissions and I thought that the projected cost of 50 billion by the year 2030 was a lot, I was mistaken. I am curious, how do you think that primary care providers can better screen at risk population for diabetes? I did several rotations with a provider and he did yearly A1c and we discussed healthy habits, including diet and exercise. However, we rarely saw improvement except when medications were prescribed to lower A1c and of course at this point in the trajectory there were already significant health complications. I appreciate you discussing the food industry as I believe in taking a functional medicine approach to all things medical! Unfortunately, the standard American diet is full of processed foods, grains, and sugars as opposed to protein, good fats, and vegetables. How can we as future providers change what is recommended by large corporations such the American Heart Association? It is challenging because a low-fat, low salt diet that is advised by the AHA often translates to carbs, carbs, carbs! I think for us to prevent diabetes it is necessary to rethink how we educate proper diet to our patients for it to be sustainable. Thank you for a thought provoking post Jessica!
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