Between 1990 and 2012, the number of US adults reporting a diagnosis of diabetes tripled. There are now more than 29 million diabetics in the US, and another 86 million are considered pre-diabetic. Given the overwhelming numbers, it was welcome news indeed to read the recent article by Greggs, et al., in The New England Journal of Medicine highlighting the success in decreasing diabetes-related complications in the US over the last 20 years.
Using data from several national sources, Greggs, et al., were able to compare the incidences of serious diabetes-related complications, including lower extremity amputation, acute myocardial infarction or heart attack, and stroke. The findings are encouraging, with rates of heart attack or myocardial infarction decreasing by two-thirds and stroke and amputation each declining by about half. Of note, these improvements in the rates of serious complication in diabetics surpassed similar reductions in the general population without diabetes and the extent of the drop in rates did not differ by sex or race. The authors cite several important areas of progress that potentially contribute to these findings, including several that have been the focus of particular interest and effort by employers — health promotion, early screening, tobacco policies, enhanced management of cholesterol and blood pressure, and glycemic control.
However, the good news is tempered by the staggering number of people who are diagnosed with diabetes. Although the rates of complications have improved, the actual number of amputations, cases of end-stage renal disease, and strokes continue to grow because of the overwhelming growth in the absolute number of cases of diabetes. The grim reality is that despite strong improvements in management, the diabetes epidemic will continue to consume significant health resources and compromise the quality of life for millions of Americans. Still, employers should take pride in their contributions, along with the broader health community, in improving the management of this substantial population.
The best strategy for the future remains prevention, and all organizations would be wise to take vigorous action to identify and target high-risk populations of pre-diabetics and apply proven, evidence-based strategies such as those used in the NIH’s Diabetes Prevention Program in an effort to stem the tide of the newly diagnosed.
There are a number of effective programs with solid track records in the market, ranging from established vendors such as UnitedHealth Group and The Diabetes Prevention and Control Alliance, to newer entrants such as EOS and Omada Health, which offers digital programs guided by live health coaches.
Changes in Diabetes-Related Complications in the United States, 1990–2010 Edward W. Gregg, Ph.D., Yanfeng Li, M.D., Jing Wang, M.D., Nilka Rios Burrows, M.P.H., Mohammed K. Ali, M.B., Ch.B., Deborah Rolka, M.S., Desmond E. Williams, M.D., Ph.D., and Linda Geiss, M.A.N Engl J Med 2014; 370:1514-1523April 17, 2014DOI: 10.1056/NEJMoa1310799