Learning About Diabetes: Perspective on the Prevalence and Economic Burden of the Disease

WHAT IS DIABETES?
There are three major types of diabetes:

  1. Type 1 diabetes, is an autoimmune disease, which is generally onset in children and young adults and is characterized by the loss of the pancreas’ ability to produce insulin.

  2. Type 2 diabetes is primarily found in adults who have resistance to the action of insulin and insufficient insulin to overcome that resistance.

  3. Gestational diabetes generally occurs in the second trimester of pregnancy. It is associated with both maternal and fetal complications such as malformations, babies who are large for gestational age, and neonatal hypoglycemia (low blood sugar). Children born to mothers who have gestational diabetes have a high rate of obesity and diabetes in their teens or early adulthood. Gestational diabetes usually disappears in the mother after delivery, but has a high likelihood of returning as Type 2 diabetes in the next five years.

Diabetes is a challenging disease to manage, and it can be debilitating. Keeping blood sugar levels within an ideal target range can be complicated. Blood sugar is normally kept in a narrow range by insulin, a hormone produced by the pancreas in response to increases in blood sugar (glucose). Insulin drives sugar from the blood into all tissues — including the brain — where it is used as fuel for the body’s normal functions. When insulin is either produced in insufficient amounts — or doesn’t work as well as it should (insulin resistance) — the blood sugar rises above the normal range, resulting in a condition called diabetes mellitus.

THE PREVALENCE OF THE DISEASE
The International Diabetes Federation calls diabetes a “global emergency” in its Diabetes Atlas.  Among all non-communicable diseases, diabetes is the fourth leading cause of mortality after cardiovascular disease, cancer, and respiratory diseases.

Worldwide, diabetes affects 425 million people — about half of whom are undiagnosed. Diabetes is projected to affect 629 million people by 2040.  From an international standpoint, China has the highest number of persons with diabetes (PWDs), with about 114 million. The U.S. has about 30 million PWDs.

Over 90 percent of PWDs have Type 2 diabetes. An even more worrisome fact is there are 352 million people worldwide (83 million in the U.S.) with pre-diabetes — an asymptomatic condition that has a high rate of conversion to diabetes within five years.

HEALTHCARE ECONOMICS
The economics of diabetes is staggering. As of 2015, diabetes cost $673 billion worldwide. By 2040 that cost will rise to $802 billion. The U.S. spends the most by far on diabetes care out of any country ($320 billion), which is more than the next nine countries – China, Germany, Japan, Brazil, France, Canada, Russia, Italy and the United Kingdom – combined.

TREATING THE DISEASE
While diabetes can result in debilitating and devastating complications such as blindness, kidney failure, amputations, and cardiovascular disease, the good news is that all types of diabetes can be effectively treated with a combination of medication and lifestyle changes, including diet and exercise. To prevent these types of complications, those living with diabetes should strive to keep their blood sugar to as close to normal as possible. Type 1 diabetes is treated with insulin, Type 2 diabetes is treated with oral medication, non-insulin injectable medication and/or insulin, and gestational diabetes is treated with either oral medication or insulin.

A blood test done every 3 months – the hemoglobin A1C (HbA1C) – represents an average glucose over the previous 90 days, thus permitting the healthcare provider to assess how well controlled the sugar has been over that time period.  An HbA1C under 7% is the goal for most persons with diabetes (PWDs) because large randomized controlled trials have proven that by achieving that goal, the complications of diabetes can be avoided.

THE BURDEN ON PATIENTS AND PHYSICIANS
The not-so-good news is that about half of PWDs are not at this goal. There are many reasons why, but the below three are the most important:

  1. Appropriate diabetes treatment is complex and difficult to achieve given that PWDs typically see their healthcare provider for 10-15 minutes every 90 days. They are expected to self-manage their disease between visits, but have limited amount of information about how well or poorly they are doing – even if they are doing blood sugar checks at home. Blood sugar checks are conducted by pricking their fingers to obtain a drop of blood which measure the sugar on a portable glucose meter. 
  2. Healthcare providers have their own challenges in managing patients with Type 2 diabetes due to the myriad of available drugs and drug combinations. A recent review of data from a large U.S. health insurer with more than 6 million PWDs showed more than 600 different drug combinations were used in a one-year period. 
  3. HbA1C used to measure control. While PWDs and their healthcare providers have traditionally relied on HbA1C as the main measure of how well their diabetes is controlled, the diabetes community has reached a consensus that providers must go “beyond HbA1C” to understand what is really going on day-to-day. HbA1C reflects only the average glucose. It provides no information about the amount of time, severity, and duration of both hypo- and hyperglycemia — nor the amount of time in the desired glucose range. In fact, in the example shown below, all three have the same HbA1C.Their average glucose is the same, but clearly only the patient in the green (patient 3) is in good control.

Patients 2 and 3 depicted in the figure feel poorly when their glucose levels bounce between highs and lows every day, but have difficulty obtaining enough glucose levels using traditional finger stick methods to capture their glucose pattern. They and their healthcare providers struggle to clearly understand where, when, and to what degree there are problems.

Even when doing four or more finger sticks a day, patients often miss important highs and/or lows – especially at night when it is rare for patients to measure their glucose. Obtaining these values is critical for patients to better understand how changes in diet, exercise, and medication can improve short-term diabetes control to enhance their quality of life in addition to protecting them against long-term complications.

 ACHIEVING BETTER HEALTH THROUGH PROFESSIONAL CGM
Professional continuous glucose monitoring (CGM) – such as iPro™2 – is a technology that provides a simple yet powerful solution to achieving better health outcomes. CGM measures glucose value every five minutes 24/7 for up to six days.  A tiny sensor is inserted under the skin – which is nearly painless – and connects to a quarter-sized recorder that rests on top of the skin (Image A).

After wearing the sensor for six days, the recorder is removed and inserted into a docking station (Image B) to upload data to a computer (Image C), where the results are analyzed and a report is generated (Image D).

This is a diagnostic test that is analogous to a Holter monitor, which is used by cardiologists to assess a patient’s heart rhythm. Armed with the wealth of information that an iPro™2 provides (288 glucose values per day, for six days), the PWD and healthcare provider can better understand the effects of diet, exercise, and medication on glucose levels. The data can facilitate informed decisions about how best to change lifestyle and/or medication. Several studies have demonstrated improved diabetes control and/or a reduction in frequency and/or duration of hypoglycemia following a professional CGM evaluation, because the device can uncover previously unknown glucose patterns. Not only does iPro™2 assist in diabetes management, a recent analysis of a large health insurance database demonstrated that patients who have an iPro™2 evaluation that led to a change in their therapy had significantly lower total healthcare costs in the year following the iPro™2 evaluation.

Expanded use of professional CGM will help reduce the systemic growth of costs related to managing diabetes and help to alleviate the growing economic burden associated with treating those with type 2 diabetes. In a recently published report in the Journal of Medical Economics, Medtronic Diabetes was the first to demonstrate the significant clinical and health economic benefits of professional CGM products – including iPro™2 – for people living with type 2 diabetes, and healthcare systems.

Most importantly, professional CGM can help patients gain better control of their diabetes, and thus reduce the complications and health burden for those living with this disease.

 

 

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