By Jeff Unger, MD, ABFM, FACE

Director, Unger Primary Care Concierge Medical Group, Rancho Cucamonga, CA

SYNOPSIS: The economic burden of diagnosed and undiagnosed diabetes, gestational diabetes, and prediabetes exceeded $322 billion in 2012. The excess cost consists of $244 billion in excess medical expenditures and $78 billion in reduced productivity. This amounts to an economic burden exceeding $1000 for each American in 2012. Costs for diabetes care have increased 48% since 2007 ($218 billion).

SOURCE: Dall TM, et al. The economic burden of elevated blood glucose levels in 2012. Diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care 2014;37:3172-3179.

The American Diabetes Association reported in 2013 that diagnosed diabetes accounts for 10% of the total health care expenditures ($245 billion) in the United States. This study by Dall et al suggests that the cost of dysglycemia is much larger when one factors in expenses related to gestational diabetes, undiagnosed diabetes, and prediabetes. Although costs of individualized diabetes care has risen less than the per capita cost of national health care expenditures (19% vs 24%) from 2007-2012, increased prevalence of dysglycemia, rather than higher costs incurred per patient, is driving the economic burden of diabetes care in the United States. Gregg et al stated that the incidence of myocardial infarctions in patients with diabetes has declined 67% from 1990-2010, with stroke and amputation rates decreasing 53% and 52%, respectively.1

Reduction rates in these complications were higher among adults with diabetes than among age-matched individuals with normal glucose tolerance. This is excellent news for insurance executives who must pay for long-term complications. However, 86 million Americans have prediabetes, an increase of 7 million people since 2010. Thirty percent of these patients are expected to convert to clinical diabetes within the next 10 years, and by 2030, 30% of the adult U.S. population will be living with diabetes.

The economic burden associated with prediabetes is on the rise. From 2007-2012, the cost of managing patients with prediabetes in the United States has increased 74% from $33-$44 billion. Unless low-cost diabetes prevention efforts (lifestyle intervention, increased activity, and weight loss) are initiated, the economic burden of managing more patients with diabetes will be unsustainable for our health care system.


Screening high-risk patients for pre-diabetes is cost-effective and advisable. By spending less than $200 per high-risk screening, those patients who are diagnosed with prediabetes can be treated intensively with lifestyle interventions and, if appropriate, metformin. Such non-invasive therapies will result in a per-quality adjusted life-year gained savings for screened individuals of more than $8000.

Our goal as clinicians should be to identify high-risk patients. Once dysglycemia is diagnosed, our strategy should be to achieve the targeted lipid, glycemic, and blood pressure goals as soon as possible. We should then maintain these targets for as long as possible, as safely as possible, and as rationally as possible.


1. Gregg EW, et al. Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med 2014;370:1514-1523.

2. Zhang P, et al. The cost-effectiveness of screening for pre-diabetes among U.S. adults. Diabetes Care 2003;26:2536-2542.

3. Perreault L, et al. Regression from pre-diabetes to normal glucose regulation in the Diabetes Prevention Program. Diabetes Care 2009;32:1583-1588.

4. Unger J. Measuring the sweet smell of success in diabetes management. Ann Transl Med Doi: 10.3978/j.issn. 2305-5839.2014.08.04.

5. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033-1046.