Diabetes treatment has seen sweeping changes in recent years, as more patients are diagnosed, and as the estimated cost to Americans—$245 billion in 2012—continues to rise. People with diabetes are diagnosed earlier, live longer, and have a wider range of treatments than even a few years ago.
And pharmacists are playing a larger role in treating a disease that now affects more than 30 million people. Pharmacists help patients manage the disease and even advise potential diabetes patients on how to prevent it.
By 2012—the last time the American Diabetes Association (ADA) surveyed the expense of the disease—Americans were spending $176 billion in care associated with its treatment. The remaining $69 billion is ascribed to lost productivity. Medical costs include both direct and indirect impact, such as the way diabetes brings on or exacerbates other conditions.
“If we see someone is in the hospital with the flu, they’ll stay in longer if they have diabetes,” said Matt Petersen, the ADA’s Managing Director of Medical Information.
Peterson is putting together the next five-year report on the cost of diabetes, due out next year. “I think we’ll inevitably see an increase,” he told Drug Topics.
Diabetes is the seventh-leading cause of death in the United States, according to the CDC. Ranking diseases and conditions, however, is difficult because of overlap with other ailments, so the ADA does not try, Peterson said.
The steady climb in costs is due to the sheer numbers of Americans developing diabetes. The difference in average health-care costs between those who have diabetes and those who don’t remains about the same, Peterson said. But the rate of diabetes has grown steadily over the past half-century or so.
The increasing monies spent on treating diabetes are not going to waste, Peterson said. “We’re getting what we’re paying for,” he said. “People with diabetes are doing much better than they were twenty or thirty years ago.”
In 1960, about 1% of the American population was diagnosed with diabetes, according to the CDC. By 2015, it was 7.4%—more than 23 million people. The ADA estimates that another 7.2 million Americans have undiagnosed diabetes, accounting for almost a quarter of the 30.3 million Americans with the disease.
“We’re entering what I think is really an interesting new era for diabetes treatment,” said Robin Southwood, PharmD, CDC, BC-ADM, Clinical Associate Professor at the University of Georgia College of Pharmacy. “And we’re just at the beginning if it.”
For example, a few years ago, there were two medications for diabetes. Now there are 11 or 12 types, Peterson said. These treatments take new approaches, including blocking the kidneys from reabsorbing sugar, so glucose is urinated out of the body. Two big advancements: Blood glucose levels are measured much more effectively, and diabetes can be diagnosed earlier.
Self-management has become a major component of treating and improving the lives of people with diabetes. Advising and educating patients is one area where pharmacists are playing a larger role, said Southwood. “There is a huge need for diabetes education,” he said. “Far too few people attend diabetes education sessions.”
The role of the pharmacist in treating diabetes continues to grow. In some states, pharmacists can now order lab tests and refill prescriptions, said Mohamed Jalloh, PharmD, Assistant Professor in the Clinical Sciences Department at Touro University California College of Pharmacy. Pharmacists advise diabetes patients on lifestyle strategies such as regular exercise, he said.
They can also educate people about diabetes in programs recognized by the CDC National Diabetes Prevention Program, which is aimed at heading off the disease before it starts. Jalloh said he also hoped to see more medications that prevent diabetes.
“I do hope there’s a greater emphasis on prevention,” Jalloh said. “Prevention is more effective, and it’s safer than treating it.”