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Diabetes and its impacts on the US Economy

Diabetesand its impacts on the US Economy

Abstract

Diabetesis a collective word for a collection of metabolic maladies that aretypified by high blood sugar (hyperglycemia) which emanates from theinability of the body to produce adequate amount of insulin or bodymalfunction that hinders proper reaction to the insulin that isproduced by the pancreases. The three main types of diabetes are Type1 and Type 2 diabetes and gestational diabetes.

Atleast 7 percent of the total US population is affected by diabetes inone way or another. This translates to 22.3 million people. Diabetesis chief cause of disability and death. It is linked to lastingcomplication that impinges on most organs of the body. Research haslinked the disease with stroke, nerve damage, blindness, kidneyfailure, cardiovascular ailments and amputations. By the year 2007diabetes cost on the US economy was approximately $174 billion.Direct cost includes medical attention, treatment supplies andhospitalization while indirect cost includes, time lost from duty,diminished productivity and costs that are directly linked todisability. Individuals of all ages suffering from any of the threetypes of diabetes are prone to cardiovascular ailments. In reality,an estimated 65 percent of all individuals diagnosed with diabetesdie from cardiovascular conditions and stroke.The prevalence of diabetes is expected to increase in the UnitedStates of America. First, the proportion of the aging people isincreasing, the number ethnic groups such as Latinos and American ofAfrica origin, are more susceptible to developing diabetes isincreasing, and many Americans are overweight and inactive. By 2050the prevalence of diabetes is expected to increase by 165 percent andthis makes it a health concern for all Americans.

Thisresearch will employ prevalence based approach that coalesce thediabetes prevalence, the demographic of the United States Population,medical care costs, epidemiological data and other relevant economicstatistics into the cost of diabetes representation. The medical careexpenditure (costs) and utilization of health resources shall beanalyzed by insurance coverage, health service category, sex,ethnicity, age, medical condition and the category of health service.Principally data for this study will come from Medicare standardanalytical files and a number of national surveys conducted by theADA (AmericanDiabetes Association, 2013).

Analyzesof the occurrence of diabetes and expenditure (costs) related to thedisease by age group (&lt18,18,18–34, 35–44, 45–54, 55–59, 60–64, 65–69, &gt70years),ethnicity and race ( Hispanic, Non-Hispanic black and whiteand Hispanic other), insurance category( government –Medicaid,children health insurance, Medicare, private insurance and othergovernment supported coverage will be done. The main source of thedata that will be used in this study is American DiabetesAssociation, Medical Expenditure Panel Survey (MEPS), National HealthInterview Survey ( NHIS), the most recent national populationSurvey, National Ambulatory Medical Survey (NAMS), and other nationalMedical Surveys by various national medical institutions that arerelevant to the study. This study shall use the most recent data andinformation from these organizations to estimate the economic burdenof diabetes on the United States economy.

Thisstudy has established that more than 7 percent (22, 3 millionindividuals) of the US population is diagnosed with diabetes and thisis consuming a huge proportion of the resources. This figure ishigher than the figure that the study by American DiabetesAssociation found in their study in 2007. The figure also reveals thehuge burden that this disease has posed and continues to pose for thesociety and economy (American Diabetes Association, 2013). Also thehigher, figure also indicates the changing dietary habits andlifestyle that has increased the occurrence and prevalence ofdiabetes. The main risk factors include sedentary lifestyle, obesity,overweight, and reduction in number of deaths and development in themethods of detecting diabetes. By the end of the year 2012, diabetescost to the nation was in excess of $245 billion, which was made of$69 billion in loss of output, and $176 billion in medical care cost.Most notably at least 59 percent of the total national expenditure ondiabetes was incurred to cover for the medical cost of the segment ofthe population aged above 65 years. Additionally these studies haveestablished that yearly expenditure on healthcare, adjusting for sexand age factors, were 2.3 times more for individuals diagnosed withdiabetes compared to individual with no diabetes (American DiabetesAssociation, 2013). The cost of diabetes is augmented when all thecomplications associated with it are taken into account. While it isnot been possible to accurately calculate diabetes associated costsby complication conditions in the health care service delivery field,about 25 percent to 45 percent of emergency and hospital inpatientdepartment of diabetes attributed health expenditure were used inmanaging and treating complications emanating from diabetes. Thestudy has also established that individuals diagnosed with diabetesincur costs up to eight times the cost that individuals who are nondiabetic incur in medical expenditure (American Diabetes Association,2013).

Thisstudy also established that a significant part of the National HealthService resources are channeled towards care and treatment ofdiabetes and health conditions attributed to diabetes. The mostnotable avenue where substantial cost is incurred includes emergencydepartment, nursing facilities, hospital outpatient visits, physicianoffice visits and prescription of medicine and other supplies(American Diabetes Association, 2013). In comparison to the number ofhospital inpatients attributed to diabetes as indicated by the studyby American Diabetes Association in 2007, there has been an increase which translates to more cost on health expenditure (AmericanDiabetes Association, 2013).

Inthe year 2012 the total cost (health expenditure related to diabetes)of diabetes was projected to be $245 billion, which was a 40% risefrom 2007 when the costs were lastly estimated. The Associationestimated the cost of diabetes on the US economy by examining thefinancial burden of diabetes to the country, loss of productivity andtime, and health resources used in treating and, managing diabetes(NationalInstitute of Health, 2008).

Diabetesrefers to the malfunction of the body such that metabolic activitydoes not take place as it ought to normally perform Metabolism, isthe way that the cells utilize ingested food for oomph, growth anddevelopment (Centers for Disease Control and Prevention, 2011). Whenfood is ingested it is usually broken down into small glucoseparticles, a form from which body cells can uptake and throughoxidation produce energy. Glucose which is a monosaccharide is themost essential source of energy in the for all the body activities.When digestion is over, all simple sugars, and particularly glucoseenters into the blood streamandis taken to the cells for metabolic activity. Insulinis a necessary condition for glucose to enter the cells. Insulin is asecretion generated in the body of all healthy human beings by anorgan called pancreas (America Diabetes Association, 2013).Pancreasis a gland just behind the abdomen. When food enters the digestivetrack, especially ileum pancreatic gland secrete the apt quantity ofinsulin to facilitate movement of simple sugars from blood, which isthe transporting medium into the cells. Individuals with diabetesexhibit malfunction of the pancreatic gland such that very littleamount of insulin is produced or none at all. In certain, criticalcases, the cells fail to react properly to the insulin which issecreted by the pancreatic gland. As such glucose builds up theblood, because it does not enter the cells for oxidation, and isconsequently ejected out in urine (NationalInstitute of Health,2008).Therefore the body loses glucose which is the main source of fuel.This paper will discuss the major types of diabetes, how it affectsthe health care management systems, and its negatives effect in theeconomy of America. It will also discuss the cause and origin of thedifferent types of diabetes and it preventive measures.

Fundamentally,costs associated with this disease are chiefly determined by two mainfactors the medical costs incurred in treating and managing diabetesand the complication diabetic patients have that reduce affect theirproductivity (NationalInstitute of Health,2008).The average annual medical expenditure by a diabetic patient will bepegged on the estimates put forward by the American DiabetesAssociation in 2010 (NationalInstitute of Health,2008).Diabetes increases the vulnerability to neurological ailments,cardiovascular diseases, metabolic problems and renal complications,and the magnitude of diabetes impacts goes beyond individuals directand indirect costs to the burden the society shoulders in care andmanagement of diabetes

LiteratureReview

Typesof Diabetes

Type1 Diabetes (T1D)

ThisType of diabetes is an autoimmune malady. Auto immune diseases occurwhen the body system meant to fight foreign pathogens-immune system-attack some parts of the body (C D C P, 2011). In this type ofdiabetes the white blood cells which are the major components of theimmune system, attacks and effectively destroy the pancreatic cellsthat secrete insulin. Pancreatic cells that produce insulin in thebody of human beings are called beta cells. As such T1D springs fromthe damage of pancreatic (beta) cells by the white blood cells suchthat very little insulin is produced (C D C P, 2011). When thesituation is dire, no amount of insulin is produced from the pancreasand as such most of glucose ends up being ejected out in urine.Individuals who suffer from this type of diabetes must ingest insulinon a daily basis to remain alive (NationalInstitute of Health,2008).Even with the advancement in technology in the medical field, thereno breakthrough on what causes the white cells to attack beta cellsof pancreas, and thus inhibiting the production of insulin in thebody (America Diabetes Association, 2013). However, scientist believethat viruses, environmental elements and genetic could be the causesof T1D.

T1D account for approximately 10 percent of all diabetic incidences inthe United States of America. In most cases it develops in youngadults and children, though it also develops in older people.Symptoms of T1D develop over a short duration though the activedamage of beta cells of pancreatic cells that secrete insulin by theimmune system can start many years earlier. The most salient symptomsinclude, weight loss, excessive fatigue, increased urination andthirst and blurred vision. Individuals suffering from T1D can lapsefor fatal diabetic coma referred to as ketoacidosis. Such people willneed a daily injection with insulin or else they will die (C D C P,2011). Currentlythere are more than 22.3 million Americans that have been diagnosedwith diabetes. Markedly, this accounts for approximately 7 percent ofthe total population and as such diabetes becomes a major healthissues in the United States of America. The country is shoulderingmore than $245 billion to manage and cater for the seven percent ofthe population that is mired by this malady (NHI&ampCDC, 2012).

Type2 Diabetes (T2D)

T2Dis the most prevalent of all types of diabetes. It account for anestimated 90% of all diabetic cases in the world. It is mostlyassociated with old age, certain ethnicities, gestational diabetesphysical sluggishness and family with a past of diabetic condition(Centers for Disease Control and Prevention, 2011).Approximately, 80percent of all individuals who develop type 2 diabetes are obese oroverweight. Just like in type 1 diabetes, glucose cannot be used bythe cells to generate energy. In this case the pancreatic cellsproduce insulin but a condition of insulin resistance crops up,preventing the body from using insulin. With time the the productionof insulin by the beta cells reduces significantly or stopscompletely (Centers for Disease Control and Prevention, 2011). Theresult is similar to type 1 diabetes, glucose accumulates inbloodstream and it is ejected out of the body in urine. Signs of T2Dare identical to those of type 1. However in some few isolated casesno symptoms are visible in people suffering from type 2 diabetes. T2Dcan stay unnoticed for many years until symptoms appear or regularblood test is done(Knowler, et al, 2002).As aforementioned, individuals with type 2 diabetes are but notexclusively overweight. As such this type of diabetes can be managedthrough physical exercise and diet .All the same after certainduration, such individuals will still need to ingest insulin in orderto control the proportionof agingpopulationglucose level in blood (Knowler,et al, 2002).

GestationalDiabetes

GestationalDiabetes affects expectant mothers. One out of every 25 pregnantwomen develops this type of diabetes. In the United States 3 outevery 8 pregnant women develop gestational diabetes (Centers forDisease Control and Prevention, 2011). Gestational diabetes alwaysdisappears after delivery but it increases the susceptibility of awoman to developing T2D. Its prevalence is higher among women infamilies with a history of the disease, some ethnic groups andoverweight women. Gestational diabetes results as a consequence ofinhibitory effects of hormones during pregnancy that reduce insulinproduction. There are no known symptoms to identify this type ofdiabetes (NHI &ampCDC, 2012).

Scopeand Impacts of Diabetes

Diabetesaffects 7.8 percent of the entire United States population, whichtranslates to 23.6 million people (Healthy People, 2013).Diabeteschief cause of disability and death. It is linked to lastingcomplication that deal a health toll on most parts of the body.Research has linked the disease with stroke, nerve damage, blindness,kidney failure, cardiovascular ailments and amputations. By the year2007 diabetes cost on the US economy was approximately $174 billion(Centers for Disease Control and Prevention, 2011). Direct costincludes medical attention, treatment supplies and hospitalizationwhile indirect cost includes, time lost from duty, diminishedproductivity, disability payments. Adult suffering from any of thethree types of diabetes are prone to cardiovascular ailments. Inreality, not less than 65 percent of total number of individualssuffering from diabetes die from cardiovascular ailments and stroke(CDC P, 2011).

ResourceBurden of diabetes on Society

Theoccurrence of diabetes is expected to increase in the United States(NationalInstitute of Health,2008).First, the proportion of the aging population is increasing, thenumber ethnic groups such as Latinos and American of Africa origin,are more susceptible to developing diabetes is increasing, and manyAmericans are overweight and inactive. By 2050 the prevalence ofdiabetes is expected to increase by 165 percent and this makes it ahealth concern for all Americans(CDCP, 2011)

Diabetesaffects an approximate 23.6 million US citizens and is the one of theleading cause of mortality in America (NationalInstitute of Health,2008).Research show that diabetes, increases vulnerability tocardiovascular diseases, reduces life expectancy by up to 15 years,it is chief cause of kidney failure, blindness and amputations(CDCP, 2011).

Costof Diabetes to the US economy

Total costs

$174 billion

Direct costs

$116 billion

Indirect costs

$58 billion—disability, work loss, premature death

Medicalexpenses for individuals suffering from diabetes are 2 times higherthan individuals devoid of diabetic condition. Additionally,individuals with diabetes are 2 times more prone to developcardiovascular ailments and 3 times to develop stroke than healthyindividuals. 68 percent of people suffering from diabetic conditiondie from a heart related disease(America Diabetes Association. 2013).Diabetes is also the primary cause of adult blindness. By the year2008, 28 percent of diabetic victims, translating to 4.2 millionpeople aged above 40 years, were diagnosed with diabetic retinopathy(NationalInstitute of Health,2008).Out of these 4 percent were at an increase risk of losing their sightfrom advanced retinopathy. Diabetes is also the major source ofkidney problems in the US. By the year 2008, 44 % of all reportedcases of kidney malfunction were associated with diabetes (AmericaDiabetes Association. 2013.

Inthe year 2012 the expenditure of diabetes was projected to be $245billion, which was a 40% rise from 2007 when the costs were lastlyestimated-(ADA, 2013). The organization estimated the cost ofdiabetes on the US economy by examining the financial burden ofdiabetes to the country, loss of productivity and time, and healthresources used in treating and, managing diabetes. Out of $ 245, $176were direct medicals costs while $69 of diminished productivity. 43percent of the total medical costs resulted from hospitalization, 18percent from prescribed medications, 12 percent from supplies, 9percent from visits to physicians and 8 percent from nursingfacilities stays (NationalInstitute of Health,2008).

Inthe United States individuals with diabetes incurs an average of$13,700 every year in medical expenditure (America DiabetesAssociation, 2013). There are many indirect costs associated withdiabetes in the US in the year 2012 $ 5 billion was lost due toabsteeism, $20.8 billion as a result of diminished productivity,$21.6 billion due to disability, $18.5 billion due to lostproductivity as a result of premature deaths (America DiabetesAssociation, 2013). This reflects the enormous weight that diabetesimposes on the economy and the general public. Further elements ofsocietal burden left out in this estimation include indefinite itemssuch as resources from the attention given by non remuneratedcaregivers, and the suffering and pain of victims (Centers forDisease Control and Prevention, 2011).

Methodologyfor evaluating the Burden of Diabetes on the US Economy

Dataand Methods

Thisstudy will use costs estimated by the American Diabetes Associationin 2010. The Diabetes model was developed ADA to evaluate theeconomic burden of diabetes on the American people and economy(America Diabetes Association. 2013).In this research the same model will be used to estimate the nationalcosts of diabetes but will be expanded to incorporate both diagnosedand undiagnosed diabetes. The model will incorporate various elementsin estimating the burden of diabetes on the US economy. Essentially,it will consider the prevalence of diabetes within different segmentsof the population determined by etiological elements such as obesityand overweight, Utilization of health care facilities and services byindividual diagnosed with diabetes and medical (direct) and nonhealth costs (indirect) borne by individuals diagnosed with diabetes.

Model determinants

Cost of diabetes to the economy

Utilization of health care by diabetic patients

Consider the frequencyof hospitalization, emergency services,

outpatients and physician office visits for

patient for each year

Foregone productivity linked to diabetes

Estimate costs associated with reduced productivity due to premature death and absteeism

Costs of health care by diabetic patients

Evaluate nominal cost increases with time, increasing the national government expenditure

Estimationof Health Costs

Fundamentally,costs associated with diabetes are primarily determined by two mainfactors the medical costs incurred in treating and managing diabetesand the complication diabetic patients have that reduce affect theirproductivity. The average annual medical expenditure by a diabeticpatient will be pegged on the estimates put forward by the AmericanDiabetes Association in 2010 (NationalInstitute of Health,2008).Diabetes increases the vulnerability to neurological ailments,cardiovascular diseases, metabolic problems and renal complications,and the magnitude of diabetes impacts goes beyond individuals directand indirect costs to the burden the society shoulders in care andmanagement of this disease.

StudyDesign and Methods

Thisresearch will employ prevalence based approach that coalesce thediabetes prevalence, the demographic of the United States Population,medical care costs, epidemiological data and other relevant economicstatistics into the cost of diabetes representation. The medical careexpenditure (costs) and utilization of health resources shall beanalyzed by insurance coverage, health service category, sex,ethnicity, age, medical condition and the category of health service.Principally data for this study will come from Medicare standardanalytical files and a number of national surveys conducted by theADA (AmericanDiabetes Association, 2013).

Analyzesof the occurrence of diabetes and expenditure (costs) related to thedisease by age group (&lt18,18,18–34, 35–44, 45–54, 55–59, 60–64, 65–69, &gt70years),ethnicity and race ( Hispanic, Non-Hispanic black and whiteand Hispanic other), insurance category( government –Medicaid,children health insurance, Medicare, private insurance and othergovernment supported coverage will be done. The main source of thedata that will be used in this study is American DiabetesAssociation, Medical Expenditure Panel Survey (MEPS), National HealthInterview Survey ( NHIS), the most recent national populationSurvey, National Ambulatory Medical Survey (NAMS), and other nationalMedical Surveys by various national medical institutions that arerelevant to the study. This study shall use the most recent data andinformation from these organizations to estimate the economic burdenof diabetes on the United States economy.

.

Approximationof the Proportion of US Population that is Diabetes

Toarrive at the proportion of the US population diagnosed with diabetesin the year 2013, this study will combine data by the Census Bureaupopulation numbers estimated occurrence of diabetes by ethnicity,age, insurance coverage, sex, age group and whether reside in thenursing home. The prevalence of diabetes by insurance cover anddemographic (n=123,185), data from the NHIS released in 2012 shall beused. American Diabetes Association used 2004 NNHS data to calculatethe incidence of diagnosed diabetes in the United States. The mostrecent data from NNHS were released in 2004, and there have been noupdate since then. Among all the institutionalized population, 24% ofAmerican Diabetes Association analysis came from NNHS data releasedin 2004. The same data and information will be applied in this studyto calculate the incidence of diabetes among the institutionalizedpopulation. 32% of nursing home residents, are diagnosed withdiabetes based on a nationwide representative study that took intoconsideration , prescription claims records and dataset files toidentify individuals with diabetes. On the guideline of this updateddata on diabetes incidence among nursing home populace, estimation of(ethnicity, sex and age group) occurrence of diabetes using similardistribution of the population demographic elements as depicted bythe NNHS in 2004, conducted among 1.6 million residents in nursinghomes in 2013. Scant data is available on the occurrence of diabetesamong non-civilians segment of the population or more specificallyfor institutionalized residents apart from those residing in nursingresidents, for instance prisons.

Assumptionwill be made that this segment of the population in institutionalizedfacilities with the exceptions of nursing homes, have a similar rateof prevalence with normal civilians. Table 3 indicates the prevalenceof diabetes among population subgroups, based on gender, age,ethnicity and insurance coverage. It combines the data from NNHS andNHIS. As depicted on the table the prevalence of diagnosed diabetesis fairly higher in males as compared to females. The prevalence alsoincreases with age in both genders and non-Hispanic black exhibit thehighest incidences of this malady. Examination of the incidence ofdiagnosed diabetes among individuals aged 65 years and above, showsthat 13.4 percent has a government sponsored medical insurance, forexample, Medicaid or Medicare in comparison to 4.6 percent that areinsured by private firms’ ad 3.7 percent that are not insured.

Methodologyfor evaluating burden of diabetes to the US economy

Methodsand Data Collection

Thisresearch will use data from the American Diabetes Association, 2010.The model of diabetes was developed by ADA to evaluate the cost ofdiabetes on the American economy and on the whole society.

Itincorporates both diagnosed cases and undiagnosed diabetes. Also,this study will incorporate various elements in estimating the burdenof diabetes on the US economy. Ideologically, considerations are doneon the prevalence of diabetes within different demographics of thepopulation determined by etiological elements such as obesity andbeing overweight, utilization of health care facilities and servicesused by individuals already diagnosed with diabetes. Direct costsi.e. medical and indirect costs i.e. non-medical incurred by peoplewith diabetes.

Costimposed by Diabetes on Economy

Thesecosts are grouped into two categories namely:

a) Directcosts

b) Indirectcosts

Thetable below can give a grim picture of these costs though it just asummary and not too detailed.

Total costs

$174 billion

Total Direct costs of diabetes

$116 billion medical costs

Total Indirect costs of diabetes

$58 billion—occurring due to disability, work loss, early death

Asummary table showing diabetes cost in the US

Fromprevious research health care costs for people diagnosed withdiabetes are as two times high compared to individuals withoutdiabetes. In the year 2012 the American Diabetes Associationestimated diabetes costs in the US economy by examining the financialburden of diabetes to the country, resources used in treating,managing and preventing diabetes as well as loss in time andproductivity. According to this association an individual withdiabetes in the US spends an average of 13,700 dollars in medicalexpenditure.

Estimationof direct costs

Theestimation of health resource utilization by individuals diagnosedwith diabetes, will take into account the excess resource use far andabove the resource utilization expected in the absence of diabetes.Additionally, since diabetes is associated with a myriad of diseasessuch as cardiovascular ailments, renal, neurological, endocrine andperipheral and other health complication, the resources used tomanage and treat these diseases attributed to diabetes. Diabetessubstantially augments the costs of managing and treating healthcomplications not directly connected to diabetes. As such the healthexpenditure of catering for these ailments is attributed to diabetes.

Increasein health care resources use linked with diabetes can be quantifiedfrom various studies conducted by researchers in the past. Howeversome problems arise to the approaches used. These problems crop updue to four main data limitations, namely:

a) Absencefor a unitary source od information and data that would make it morereliable and easy to interpret

b) Undersizedsample in some data supply, most are done in University hospitalswith fewer patients.

c) Correlationof both diabetes and its co-morbidities with other factors such asage, obesity and overweight

d) Unreportedcases of diabetes and its co-morbidities or just under-reporting ofdiabetes cases.

Dueto these limitations direct costs of healthcare attributed todiabetes are divided into two components

1) Costson components solely estimated on MEPS i.e. home health, diabetessupplies, podiatry, ambulance services and other provisions andapparatus. Also include in this category is nursing/ residential use.These costs can be estimated by using a model that compares theyearly per capita utilization of health care resources of people withdiabetes and for individuals without this disease.

2) Costsestimates that are pegged on analysis of the health encounterfigures. That is ambulatory visits, hospital inpatient and emergencycare. In this respect all the risks linked to methodology is applied.This type of methodology is usually used when estimating theutilization of helath resources by a given segment of the populationwith the condition under study, in comparison to the demographicsegment without the health condition. The frequency ratio will beused for both the ambulatory and emergency visits.

Assumptionstaken on the Two Categories

Thefirst component cannot be applied with some general data sourcesanalyzed such as patient discharge files from hospital visits. Thesefiles may or may not identify whether or not a patient has beendiagnosed with diabetes or indeed they haven’t been diagnosed withdiabetes. Also, it is difficult to get this kind of information dueto doctor-patients’ confidentiality agreements that protect theprivacy and information of the patient.

Estimatingthe Indirect Cost attributed to Diabetes

Thereare numerous indirect costs attributed to diabetes, and this includeworkday missed as a result of absenteeism, diminished workproductivity at the workplace due to poor health associated withdiabetes, reduced employee engagement due to health conditions andproductivity lost as a result of early mortality. Productivity lossdue to health conditions occurs to individuals in employment andnon-employed. To approximate lost productivity, the number of daysmissed by workers (absenteeism), decreased work productivity as aresult of presenteeism, reduction in employee engagement due tohealth conditions and number of work year lost as a result of earlymortality is calculated.

Absenteeism

Thisis defined as the aggregate number of work days missed as a result ofpoor health conditions attributed to diabetes. Individuals withdiabetes posses higher rate of absenteeism as compared to the rest ofthe population who do not have diabetes. Absenteeism ranges between1.8 and 7.0% of workdays

Presenteeism

Itis generally measured by employees/ workers’ responses to surveysand questionnaires. It is regarded as the reduced productivity atwork, and those with diabetes indicates increased rates ofpresenteeism as compared to their colleagues who not have diabetes.Colleagues with diabetes have a higher rate of presenteeism comparedto their colleagues without diabetes with excess rating based onannual productivity diverging from 1.8 to 3.8%. However, some otherfactors may show increased presenteeism even with people withoutdiabetes. These factors may include weight issues (in extreme casesmay be obesity), low self-esteem and some people are just lazy orincompetent. Some individuals diagnosed with diabetes may also havethe some issues making their situation much worse.

Inabilityto Work

Individualswith diabetes may display an inability to work mainly because ofamputations done on the lower limbs. We focus on unemployment causedby long-term disability due to all these amputations as well as otherco-morbidities connected to diabetes. As all these makes it hard forsome group of people suffering from diabetes to remain in theworkforce or even get an employment in their qualified fields.Quantification of diabetic disability or simply diabetes-relateddisability is done by identifying people between 2009 and 2011 NHISfrom 18 to 65 years demographic obtaining disability payments fromSSI (Supplemental Security Income). By use of logistic regression,one can estimate the link or the relationship between diabetes, aswell as the payments receipt of SSI controlling for weight, sex,hypertension, race and age-group. After analysis one can concludethat individuals with diabetes have 2.4 percent vulnerability ofwithdrawal from labor force, as well as receiving disabilityremuneration as compared to their counterparts without diabetes. Theeffects of diabetes intensify with age and alters depending ondemographic and ranges from 0.7% rating for white males(non-Hispanic) aged from 65 to 6 9 years to 7.4% rating for theblack females who are non-Hispanic and aged between 55 and 59 years.

Declinein Productivity for People not Employed

Alsoadds to the estimates of the country burden. Loss in productivityattributable to diabetes can be derived from data gathered by theAmerican Diabetes Association. Studies conducted aimed at evaluatingthe loss in productivity as a result of diabetes. This is conductedby computing the quantity of full time equivalent days (workdays)which is lost as a result of absenteeism and decreased activities atthe workplace (presenteeism). Loss in national revenue is also takeninto account. This loss can be calculated by using daily earnings(average) for the working demographic. The non-employed demographicentail all adults who are aged under sixty-five and are not employedeither involuntarily or voluntarily. Their contribution to thenational productivity includes time spent in child care provision,voluntary efforts to community needs such as feeding the homeless andrelief aids in times of disaster. Individuals in this group sufferingfrom diabetes display reduced productivity as their time may be spentin bed nursing poor health.

PrematureMortality

Diabetesis also associated with premature mortality. This means that thesurvival of people living with diabetes is shortened and they diebefore their time. This reduces the current year productivity andfuture productivity. However data limitations prevent usage of thisapproach as for one value of lost productivity can be modeled bycalculating the number as well as the characteristics of allindividuals who can live to a particular year, take year 2012 forexample, but who died prior to that year (2012) as a result ofdiabetes. To avoid this one estimates the number of premature deathsresulting from diabetes in 2012 and get the current value of theexpectation of their earnings in future. Loss in productivity linkedto early mortality can be approximated by computing the Net PresentValue of productivity to occur in future for people taking intoconsideration race and age.

Causesand origin of the Different types of Diabetes and it PreventiveMeasures

IrreversibleRisk Factors

Irreversiblerisk factors that lead to the development of diabetes are factorsthat cannot be modified through lifestyle modification or diet. Theyare factors that make a person more susceptible to developing one ofthe three major types of diabetes.

Ethnicity

Theoccurrence of diabetes and more specifically Type 2 diabetes variessignificantly depending on ethnicity and race of an individual.Research has found high occurrence of diabetes among Asian Indians,Latinos and African Americans in the US (AmericanDiabetes Association, 2013).While environmental factors come into play in determining whodevelops diabetes, some ethnic groups have been reported to have ahigh prevalence of diabetes than other (NHI&ampCDC, 2012).

FamilialAggregation

Individualswho come from families where there is a history of diabetes aresusceptible to develop diabetes than those who come from familieswhere there have never been cases of diabetes. As such family historyis a practical but crude way of identifying individuals expected tohave inherited vulnerability to the disease from their parents.Nonetheless, individuals can still develop the disease even whenthere is no past diabetic case in the. Exposure to differentenvironmental conditions can lead to the development of diabetes insome members by chance.

GeneticFactors

Genetichas been a major determining factor on who develop diabetes,particularly Type 2 diabetes. The high concordance of diabetes inidentical twins in relation to dizygotic twins is a proof thatgenetic factors are central in determining propensity to the disease(NationalInstitute of Health,2008).Nonetheless, the fact that not all monozygotic twin are concordantfor diabetes validate that environmental elements play a major partin predisposing an individual to diabetes. In the US there is highprevalence of diabetes in Americans of Indian origins than in Indianswho have mixed with other ethnic groups. High prevalence of diabetesis linked to the Indian genes. However, it still very difficult toquantify, how much genetic factor lead to the development of diabetes(NHI&ampCDC, 2012).

Ageand Gender

Thepredisposition to diabetes increases with increase in the age, thoughthe pattern of occurrence differ significantly depending on exposureto other risk elements such as lack of physical activity andoverweight(Knowler, et al,2002).In high incidence populations, the occurrence of the disease increasesubstantially in the younger adult, whilst in low incidencepopulations, the prevalence of the disease is more in oldergenerations. In both Europe and US, the prevalence of diabetesincreases with age in Caucasian population(NationalInstitute of Health,2008).In the past,type 2 diabetes occurred mainly in adults, but in the recent pastoccurrence in adolescents and children has been increasing.Type2 diabetes was first identified among American Indian children andthe occurrence of the disease hasbeen increasing gradually forthe last 30 years. Additionally reports of type 2 diabetes, which isthe mostly found among the three notable forms of diabetes, in youngchildren has appeared in American of African origin, MexicanAmericans and Arabs and Polynesians. Evidently, it emerges that type2 diabetes is still infrequent in children among Caucasia population(Centersfor Disease Control and Prevention, 2010).

ReversibleRisk Factors

Reversiblefactors are associated with individual’s life style and dietaryhabits, which predispose them to diabetes. These elements have beendiscovered to either decrease or augment the vulnerability todiabetes. Luckily they can be changed in order to internalizedeviations in insulin levels in the blood (Centersfor Disease Control and Prevention, 2010).

Obesity

Obesityis a term generally referring to those having excessive fats. Moreformally, the term is used to refer to people with imbalanced bodyweight in relation to their height. The body mass index is used tocalculate whether an individual is obese or not. The weight isdivided by the height (kg/m2). Individuals having body mass indexwhich is equal or greater to 5 are considered as overweight, thosewith more than 30 are described as obese ad those with more than 40are regard as exceedingly obese. Manylongitudinal researchers have identified obesity as a powerfulpredictor leading to growth of diabetes in young children as well asadult. In the recent past obesity has increased steadily as aconsequence of the interface between environmental elements f andgenetic factors (healthy People, 2013).

Thesefactors include high energy intake and physical inactivity. The bodymass index has therefore become an important determinant on theprevalence of diabetes in many populations. Individuals with higherbody mass index are more susceptible to diabetes than those withlower body mass index. The distribution of body fats in the body hasalso been a determining factor. Waist circumference indicates thevisceral and abdominal obesity. For instance, in Americans ofJapanese origin the intra- abdominal fat, is the one of the mostreliably ways to predict the occurrence of diabetes (NationalInstitute of Health,2008).

PhysicalInactivity

Numerousstudies have revealed that physical indolence is chief cause ofdiabetes, and particularly T2D (America Diabetes Association, 2013).Nurses’ Health Study indicates that more physical activity reducesthe predisposition of individuals to diabetes, since it perks up thesensitivity of the body to insulin. This study also revealed thatsensitivity to insulin improved substantially in insulin resistantindividuals undertaking vigorous physical activity than those whoundertook mild physical activities. Lack of activities which isphysical in nature is always associated with obesity, which is anotable cause of T2D (Centers forDisease Control and Prevention, 2010).

Quantityand Quality of Fat

Thequantity and quality of aft ingested by an individual may alterglucose tolerant and insulin sensitivity in the body (AmericaDiabetes Association, 2013).Evidently a diet with a high quantity of fat may increase glucoseintolerance through reduced binding of insulin to its receptors.Consumption of too much fat has been High fat intake has beenreported to augment a woman’s susceptibility to gestationaldiabetes.

PreventiveMeasures

Goalsof Diabetes Intervention

Physical activity

Weight loss

Reduce total fat

Other dietary goals

Diabetes prevention program

150 minute/week of moderate activity

Initial body weight

Low fat diet

Low calorie and cholestroe

Asaforementioned the genetic makeup that a person inherits from theparents may predispose them to type 2 diabetes, but an individual’slife style and behavioral factors always play a significant part inthe development T2D. Research by Nurses’ Health reveals that about90 percent of women who suffer from type 2 diabetes have behavioralfactors such as, smoking, too much weight, lack of exercise andunhealthy diet (NationalInstitute of Health,2008)

.This study that involved 85,000 female nurses showed that women inlow risk group less prone to develop T2D than those in high riskgroup (America Diabetes Association, 2013). Low risk group meant thata woman had a healthy diet, weight (BMS less than 25) and was a notsmoker and had a maximum of three alcoholic drinks every week(Healthy People, 2013). Identical study in men revealed similaroutcomes.

Mostof the clinical trials have indicated that type 2 diabetes can beprevented (Knowler, et al,2002). The Diabetes Prevention Program (NationalInstitute of Health,2008) evaluated the impacts of physical activity and weightloss in women and men exhibiting high levels of blood sugar, but thathas not reached diabetic levels. The study showed that there werefewer cases of diabetes in the group that was assigned to physicalactivity and weight loss than those in the regular health care. Thesusceptibility to diabetes was reduced by 58% (Centersfor Disease Control and Prevention, 2010).

RiskReduction to Developing Diabetes

Oneof the notable milestones in preventing the development of diabetesis weight control. Obesity and excess weight are a major cause oftype 2 diabetes. Research indicates that, excess weight raises therisk of developing diabetes seven times (NHI &ampCDC, 2012). Obesityon the other hand increases vulnerability to diabetes by 20-40 timesthan health individuals (Havard School of Public Health, 2013).Physical activity helps individuals to work their muscles, whichmakes them improve their capacity and ability to utilize insulin andtake up glucose. Evidently, this reduces the amount of stress on betacells. Nurses’ Health Study (NationalInstitute of Health,2008) showed that even walking vigorously for 30 minutes dailycan lower the chances of developing diabetes by up to 30 %(Centers for Disease Control and Prevention, 2010).. Watchingtelevision has been highlighted as the most common form of inactivitythat promotes diabetes. Study show that for each hour spent onwatching television, the chances of having diabetes is increased toaround 20 percent. It also augments the chance of developingcardiovascular ailments by 15% and premature death by 13% (HavardSchool of Public Health, 2013). Additionally, the more televisionpeople watch, the higher the chances of becoming overweight andobese.

Choosinga diet that is rich in grain products can also play a significantpart in preventing occurrence of diabetes. In the Nurses’ Healthstudy it was prevalent that consumption of grain product helpsindividuals against developing diabetes by 30 %. Whole grains are notmade up of nutrients that help fight against diabetes, but their formand structure is what makes them primarily advantageous in reducingrisk of developing diabetes(Knowler, et al, 2002) Most notably the fiber in the grainsslows down the rate of their digestion and release of glucose intothe blood stream. In other words, whole grains have low glycemicindex. Consequently, stress on the insulin producing beta cells isless, and this is what prevents the development of diabetes.Likewise, grains are rich in vitamins and other phytochemicals whichassist in reducing the occurrence of diabetes.

Avoidingfood that have high glycemic index such as bread, donuts and ricethat cause spikes in blood sugar may reduce risk to diabetes(NationalInstitute of Health,2008). The Nurses’ Health Studies revealed that substitutinghigh glycemic index foods such as white rice with whole grains canhelp reduce the risk of developing diabetes by 36% (Havard School ofPublic Health, 2013).. Avoiding sugary beverages is also important inpreventing the development of diabetes. Just like refined grains,these drinks increase chance of developing diabetes. In the Nurses’Health Studies 1 and 11, women who drank more sugary beveragesdepicted a higher chance of diabetes than those that did notfrequently use such drinks (Havard School of Public Health, 2013).Excessive weight and obesity are usually associated with refinedgrains and sugary beverages, and they are the major cause of type 2diabetes. Drinking water and other calorie free drinks such as teaand coffee can help prevent the occurrence of diabetes.

Pickinggood fats as part of the daily diet can help prevent occurrence ofdiabetes. Fats are described as good if they are not saturated. Theyare mostly found in vegetables and a variety of nuts. Saturated fatslike ones found in margarines and fast foods are bad fats and cancause diabetes (NationalInstitute of Health,2008). Red meat has the same effects as bad fats and refinedgrains. Result from the Nurses’ Health Studies revealed that redmeat even when consumed in a small amount can lead to the developmentof diabetes. The high amount of iron in the meat is believed to havedamaging effects on beta cells that produce insulin. In this healthstudy 440,000 married female nurses were evaluated, and out of these28,000 developed diabetes in the course of the study. It was evidentthat red meat93-ounce) could increase the chances of developingdiabetes by 20%. Substituting red meat with fish, poultry and wholegrain can help prevent the occurrence of diabetes or delay itsmaterialization (Havard School of Public Health, 2013).

Anemerging body of knowledge claims that modest use of alcohol canassist decrease the occurrence of diabetes and cardiovascularailments. Moderate consumption is hard to define, but physicians takeit to mean one and two drink (s) daily for a woman and manrespectively, and is alleged to increase the efficiency of insulin ataiding the movement of glucose inside the cells ( Havard School ofPublic Health, 2013). However excessive consumption of alcohol hasbeen found to raise the risks of acquiring cardiovascular ailments aswell as type 2 diabetes. Health living, healthy eating ad healthydrinking is the only sure way of preventing type 2 diabetes.

Discussion

Thereare about 22.3 million people from the US diagnosed with diabetes.This number accounts for about 7 percent of the total population andevidently making diabetes a health concern. US are incurring morethan $245 billion in expenditure to cater for the 22.3 million sickpeople.

Thetable below shows the proportion of national resources used to caterfor individuals diagnosed with diabetes. An approximated 25.7 percentof working days are lost ad this is lined to the medical conditionsattributed to diabetes. About 1/3 of residential facility days faceindividuals having diabetes, more than ½ of them directly related todiabetes. Approximately 50% of hospital outpatient visits, medicationprognosis and physician visit acquired by individuals suffering fromdiabetes are associated to their diabetic condition.

Tabletwo depicts the proportion of health services that each of thedifferent categories of age group in our study utilize. Individualsaged 65 and above consume significantly higher number of healthservices, especially hospital inpatient days as well as nursingresidential facilities more than any other age group category. Thesubstantial increase in nursing days associated with diabetes depictsthat the prevalence of diabetes among individuals aged 65 and aboveis higher than other age groups in the study. This section of thepopulace has the highest number of visits to physicians, hospitalinpatients days (63%), nursing facility days (80%), hospital days(91%), home health visits (47%), Emergency department visits (57%)and medication prescription (60%). Evidently individuals aged above65 years pose the highest burden on the US economy. Individualsdiagnosed with diabetes aged 45 years and below pose the smallestcost burden to the economy. Individuals aged 45 years and aboveimpose moderate costs on the US economy and society.

Tablethree shows how resources have been used to manage medical conditionsattributed to diabetes. These health conditions and diseaseattributed associated with diabetes consume a huge proportion of theresources meant for health care in the United States.

Thetable also shows that a huge part of the resources channeled towardsmaintaining a health nation is spent to treat general conditionsassociated with diabetes. A significant part of resources is used tomanage chronic health conditions associated with diabetes.Specifically, the general conditions linked to diabetes account for54 percent and 68 percent of all the hospital inpatient days andemergency visits. Most notably diabetes accounts for 39 percent ofthe hospital outpatients visits and 33 percent of physician officevisits. This reveals the colossal sums of money that individuals withdiabetes use in the management and treatment of diabetes. The healthcost associated with diabetes mirror the additional expenditure thatthe nation and society sustain because of diabetes. Statisticallythis is equal to the aggregate amount of financial resources used tocater for health needs of individuals with diabetes minus the part ofexpenditure that is used to cater for health needs of individuals whoare non diabetic. To arrive at the apt figure of national expenditureon diabetes and other related diseases, the cost that the nationincurs to cater for the health requirement of citizens who are nondiabetic must be put into consideration.

Tablefour (below) sums up the total cost that the nation bear because ofdiabetes. The figure is to the excess of $1.3 trillion. The nationincurs about $3.6 billion in expenditure by individuals withdiabetes. This accounts for about 23 percent of the total healthcareexpenditure. When all the other disease associated with diabetes isincorporated the figure goes to the excess of $176 billion which isapproximately 57 percent of the total medical costs borne byindividuals with diabetes. Statistically, 10% health care costs areassociated with diabetes.

Thetotal national expenditure could be higher than portrayed in thetable above due to the fact that some national expenditure are leftout in the study for lack of reliable data on the accurate amount ofmoney spent. These include, cost of administering insurance programsfor both the government and private companies. Over the counterprescription, visit to non- physician and diabetes management andwellness programs.

Fromthe table it is evident that more than 40 percent of the nationaltotal health expenditure associated with diabetes originates fromhigher rates of admission sin hospitals and the long duration ofhospital admission. 26 percent of the total cost incurred in hospitaladmission is associated with diabetes, and out of this proportion,about $76 billion is directly linked to diabetes. Over a quarter ofthe total health cost attributed to diabetes emanates frommedications. Approximately $77 billion is used for medication fordiabetic individuals and out of this 50 percent is directly relatedto diabetes.

Individualsdiagnosed with diabetes and aged above 65 years account for about 59percent of all the total national expenditure associated withdiabetes. A significant part of this cost is covered by Medicareprogram. It is clear that, the population segment aged between 45 and64 accounts for about 33 percent of all the total costs linked todiabetes. The section of population under the age of 45 accounts foronly about 8 percent of the total national expenditure attributed todiabetes. To get the average yearly expenditure per individual, wedivide the total national expenditure linked to diabetes with entirenumber of individuals suffering from diabetes. For the populationgroup aged below 45 years the cost is $4,394, 45-64 is $5611 and forthose above 64 years the cost is $11,825. Table six depicts the totalhealth expenditure for the different ethnic groups and sexes.

Fromthe data analysis in table six, the number of health cost increaseswith an increase in age of the diabetic individuals. This significantdifference is observed as a result of the high rates of nursingfacility and hospital inpatient resource use by individuals aged 64years and above.

Table6

Table7 (below) sums up the health cost attributed to diabetes, forexpenditure mirrored by medical complications. It is clear that thehighest cost incurred under this category falls under hospitalinpatient. Apart from diabetes, cardiovascular ailments and othermedical complications linked to diabetes is the major contributor tothe medical expenditure associated with diabetes. The two conditionsaccount for about 78 percent of the total hospital inpatientexpenditure, 52 percent of total hospital outpatient expenditure, 82percent of the total emergency visits and 47 percent of physicianvisits, attributed to diabetes.

Proportionof medical expenditure depending on medical complications

Table8 (below) summarizes the difference between expenditures forindividuals diagnosed with diabetes and expenditure for individualswithout diabetes. Data from table six indicate that the oldergenerations has a higher prevalence of diabetes than the rest of theage group. After the adjustment for the sex and age factors,individuals with diabetes is higher by a factor of 2.3 ($13,741 vs$5,853) expenditure which can be expected for same population ifdiabetes is not present. The implication is the fact that, diabetescan be linked with over $ 7,888 towards expenditure for everyindividual with diabetes.

Table9 (below) shows the total indirect cost incurred by the society as aresult of diabetes. The total indirect costs are in excess of $68.6billion. The biggest part ($21.6 billion) of this cost emanates fromunemployment caused by disability linked to diabetes, presenteeismaccounts for $20.8 billion, early mortality $18.5 billion, diminishedproductivity $2.7 billion and absenteeism $55 billion. This totalweight of diabetes on the society and the economy is substantiallyhigh.

Approximately30 percent of total indirect costattributed to diabetes emanatefrom presenteeism. Approximation of this data reveals that 6.6percent yearly decrease in productivity linked to diabetes translatesto about 113 million days of work lost every year. The mean dailyearning is $185 for the segment of the population that is employed,which translates to $20.8 billion in annual expenditure associatedwith diabetes. In this approximation abstenteeism is factored out toavert double counting.

Earlymortality recorded by end of year 2012 was 246,000. This is depictedin table 10. Out of these deaths 73,000 are attributed to diabetes.The actual number of early mortality (deaths) contributed bycardiovascular complications was 687, 0000, 16 percent are associatedwith diabetes. An estimated 38, 00000 individuals had cerebrovascularailments, identified as the main cause of mortality, were linked todiabetes, 25,000 cases of having renal ailments identified as thenotable cause of mortality linked with diabetes. The mean expenditure(cost) for all early mortality reduces as age increases.

Table10b (below) sums up the approximation of the present value forindividuals who dies at a different age segment. The table (10)gives a summary of the future income that would accumulate to theeconomy and which would be generated by a person if they had livedbetween 18-34, 35-44, 45-54, 55-59,60-64,65-69 and above 70 years.The highest loss of productivity occurs when individuals die at theage of 18-44 years. Generally, this constitute the most productiveyears of a person’s life. The PVFP varies between the different agegroups because of the variations in average earnings, the duration anindividual is expected to remain in the labor force and theproclivity to be in the labor force.

Thetotal cost of workdays missed as a result of poor health linked todiabetes is estimated to be $5 billion. This accounts for about 25million work days. On average the total loss of productivity forevery individual with diabetes, above 18 years is $3,100. Table 11(below) depicts per capita approximation for men ($6,844) between theage of 45-54 and for women ($647) above 70 years.

Thisstudy has established that more than 22.3 million people in UnitedStates of America are diagnosed with diabetes by the end of 2013.This figure is higher than the figure that the study by AmericanDiabetes Association found in their study in 2007. The figure alsoreveals the huge burden that this disease has posed and continues topose for the society and economy. Also the higher figure alsoindicates the changing dietary habits and lifestyle that hasincreased the occurrence and prevalence of diabetes. The main riskfactors include sedentary lifestyle, obesity, overweight, and reducedmortality as well as improvements in the methods of knowing a personhaving diabetes. By the end of the year 2012 diabetes cost to thenation was in excess of $245 billion that consist of $176 billion interms of costs in medical care, $69 billion associated to loss ofoutput, Most notably at least 59 percent of the total nationalexpenditure on diabetes was incurred to cover for the medical cost ofthe segment of the population aged above 65 years. Additionally thesestudies has established that yearly expenditure on healthcare, adjustfor sex and age factors, was times 2.3 higher for people diagnosedwith diabetes in comparison to those not having diabetes.

Thecost linked to diabetes is augmented during the time all thecomplications associated with it are taken into account. While it isnot been possible to accurately calculate the diabetes associatedcosts by complication conditions in the health care service deliveryfield, about 25 percent to 45 percent of emergency and hospitalinpatient department of diabetes attributed health expenditure wereused in managing and treating complication s emanating from diabetes.The study has also established that individuals diagnosed withdiabetes incur costs up to eight times the cost that individuals whoare non diabetic incur in medical expenditure.

Thisstudy also established that a significant part of the National HealthService resources are channeled towards care and treatment ofdiabetes and health conditions attributed to diabetes. The mostnotable avenue where substantial cost is incurred includes emergencydepartment, nursing facilities, hospital outpatient visits, physicianoffice visits and prescription of medicine and other supplies. Incomparison to the number of hospital inpatients attributed todiabetes as indicated by the study by American Diabetes Associationin 2007, there has been an increase which translates to more cost onhealth expenditure.

Consequently,as a result of the high occurrence of diabetes, the utilization interms of health resources has also increases proportionately. Inreality, In this study the $245 billion in the medical cost incurredby the end of 2012 ($176 billion) reflected a 30 percent increasefrom the cost estimated by American Diabetes Association in 2007. The indirect cost ($69) incurred as a result of diabetes has alsoincreased significantly. Indirect cost of indirect increaseproportionately with the prevalence of diabetes. Cost such as thoseemanating from absenteeism ($5billion), diminished employeeproductivity($20.8 billion) and diminished productivity for theunemployed($2.7 billion) and joblessness brought by disability linkedto diabetes ($21,6 billion) and total loss of productivity caused byearly mortality estimated to be $18.5 billion

Inthis study the 4245 billion indicates the cost of diagnosed diabetesto the society. The cases of people who had diabetes which wasundiagnosed would increase this cost to an even higher margin.American Diabetes Association has estimated the number of thosehaving undiagnosed diabetes to be over of 6.3 million people. If thisis internalize, ($25 billion) in the cost of diabetes incurred by theend of 2012 in United States it would increase to $275 billion. Onthe façade it seems as if the financial burden of diabetes fallslargely on insurance companies and government who cover a significantpart of the medical costs of workers. In reality, the burden ofdiabetes foes far and above the coverage offered by insurance firmsand government. It also encompasses the higher taxes that thecitizens have to pay, decreased earning and reduction in the standardof living.

Anin-depth understanding of the cost that diabetes imposes on thesociety and the economy is very useful for policy makers. The highburden it imposes on everyone is a wakeup call for the government tomake a crucial decision and policies that will reduce the prevalenceof the disease. The changing lifestyle, dietary habits and lack ofphysical activity has been the main cause of diabetes, especiallyType 2 diabetes. Consequently, one third of total US citizens will bediabetic by 2050 if no policy decision is made to reverse the trend.

Toobtain the most succinct burden imposed by diabetes on the society,the full impacts of diabetes should be evaluated. This study did notlook at the cost by families and parents when they are forced out ofemployment to cater for their diabetics’ children. As aforesaid,the prevalence of Type 2 diabetes has been increasing in youngchildren, chiefly because of the sudden change in lifestyle andadoption of sedentary life. Also all the mechanisms that thegovernment has put in place, for example wellness program are notconsidered in this study. Evidently the stress resulting diabetes canbe higher as compared to figures indicated due to these limitationsthe study.

Conclusion

Diabetesresults from the malfunction of the pancreatic gland such that verylittle or no amount of insulin which is body. There are three notabletypes of diabetes namely Type 1 diabetes, gestational diabetes andtype 2 diabetes. As far as Type 1 diabetes is concerned, white bloodcells that constitute the immune system, attack as well aseffectively destroy the pancreatic cells responsible for theproduction of insulin. Pancreatic cells that produce insulin in thebody of human beings are called beta cells. As such type 1 diabetescomes up when destruction of beta cells by the white blood cells suchthat little insulin is produced. The reason of Type 1 diabetes is notyet known. In Type D the pancreatic cells produce insulin but acondition of insulin resistance crops up, preventing the body fromusing insulin. T2D is associated though not per se with obesity,overweight and lack of physical activity. As such this type ofdiabetes can be managed through physical exercise and diet.Gestational Diabetes affects expectant mothers. One out of every 25pregnant women develops this type of diabetes. In the United States 3out every 8 pregnant women develop gestational diabetes. It mainlyoccurs more often among women in families with a history of thedisease, some ethnic groups and overweight women. Gestationaldiabetes results as a consequence of inhibitory effects of hormonesduring pregnancy that reduce insulin production. Diabetes is thechief cause of disability and death. It is linked to lastingcomplication which affects most parts of the body. Research haslinked the disease with stroke, nerve damage, blindness, kidneyfailure, cardiovascular ailments and amputations. By the year 2007diabetes cost on the US economy was approximately $174 billion and bythe end of 2012 it was $245 billion.

Asmentioned above the genetic makeup that a person inherits from theparents may predispose them to diabetes, but an individual’s lifestyle and behavioral factors always play a significant part in thedeveloping diabetes. Currentlythere exists no known method or way to prevent type 1 diabetes. Theonly known treatment method is insulin injection to control the levelof blood glucose.Unlike type 1 diabetes, Type m2 diabetes can be easily prevented aswell as delayed through engaging in vigorous physical activity anddiet management. Studies in the United Sates and other Europeancountries have always shown that the onset of T2D can be deferred andprevented in individuals who are prone to the disease throughstructure lifestyle intervention individuals can reduce their risk todeveloping the disease by 50 percent. In most cases, this willencompass maintaining the appropriate weight depending on the age ofa person, engaging in physical activity and ensuring the quantity andquality of fat consumed in appropriate to prevent obesity. Lifestyleinterventions are applied to alter the behavior of people to helpthem eat more nutritious food, maintain a healthy body mass andengage in physical activities. Adiet that assist individuals who are obese to shed weight andmaintain the right body mass in relation to their age willeffectively reduce their susceptibility to diabetes. The increasingcases of diabetes in United States pose a huge burden to the societyand the economy in terms of costs of managing and treating thedisease.

Thisstudy has established that more than 7 percent (22, 3 millionindividuals) of the US population is diagnosed with diabetes and thisis consuming a huge proportion of the resources. This figure ishigher than the figure that the study by American DiabetesAssociation found in their study in 2007. The figure also reveals thehuge burden that this disease has posed and continues to pose for thesociety and economy. Also the higher, figure also indicates thechanging dietary habits and lifestyle that has increased theoccurrence and prevalence of diabetes. The main risk factors includesedentary lifestyle, obesity, overweight, and reduced mortality aswell as improvements in the ways in which diabetes is detected. Bythe end of the year 2012, diabetes cost to the nation was over $245billion that consist of $176 billion in terms of cost of medicalcare, $69 billion in loss of output, Most notably at least 59 percentof the total national expenditure on diabetes was incurred to coverfor the medical cost of the segment of the population aged above 65years.

Additionallythese studies have established that yearly expenditure on healthcare,adjusting for sex and age factors, were higher by a factor of 2.3 forindividuals said to have diabetes compared to those without diabetes.The cost associated to diabetes is augmented during the time when allthe complications associated with it are taken into account. While itis not been possible to accurately calculate diabetes associatedcosts by complication conditions in the health care service deliveryfield, about 25 percent to 45 percent of emergency and hospitalinpatient department of diabetes attributed health expenditure wereused in managing and treating complications emanating from diabetes.The study has also established that individuals diagnosed withdiabetes incur costs up to eight times the cost that individuals whoare non diabetic incur in medical expenditure.

Thisstudy also established that a significant part of the National HealthService resources are channeled towards care and treatment ofdiabetes and health conditions attributed to diabetes.

Themost notable avenue where substantial cost is incurred includesemergency department, nursing facilities, hospital outpatient visits,physician office visits and prescription of medicine and othersupplies. In comparison to the number of hospital inpatientsattributed to diabetes as indicated by the study by American DiabetesAssociation in 2007, there has been an increase which translates tomore cost on health expenditure.

Currentlythere are more than 22.3 million Americans that have been diagnosedwith diabetes. Markedly, this accounts for approximately 7 percent ofthe total population and as such diabetes becomes a major healthissues in the United States of America. The country is shoulderingmore than $245 billion to manage and cater for the seven percent ofthe population that is mired by this malady. By the end of 2014 thegovernment expenditure and burden that diabetes will impose on thesociety and economy is expected to even increase. All is not lostsince Type 2 diabetes that quantifies for about 90 % of all diabeticcases in America can be prevented and delayed for many years.

References

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HarvardSchool of Public Health (2013).Simple Steps to Preventing Diabetes.Retrieved from:

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KnowlerW.C, Barrett-Connor E, Fowler S.E, et al. Reduction in the incidenceof type 2 diabetes with lifestyle intervention or metformin. NEngl J Med.2002 346:393-403

NationalInstitute of Health.(2008). NationalDiabetes Statistics fact sheet: general information and nationalestimates on diabetes in the United States.U.S. Department of Health and Human Services,

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