The number of older Americans diagnosed with diabetes every year went up by 23 per cent in the decade leading up to 2003-2004, according to a new study published in the Archives of Internal Medicine carried out by researchers at the Duke University Medical Center in Durham, North Carolina.
Increasing numbers and percentages of Americans older than 65 having diagnosed diabetes is growing fast, which together with reducing death rates and lack of improvement in treating side effects, is contributing significantly to the growing burden of paying for and providing their medical care.
Dr Frank A Sloan, of Duke University Medical Center and colleagues wrote that the global prevalence of diabetes mellitus is growing, partly because the population is getting older, but also because it is rising in younger people. This is accompanied by a rise in diabetes-related complications, with an attendant increase in the need to monitor and manage the disease.
Sloan and colleagues comment also that "adherence to recommended practices remains low".
The researchers looked at trends in the rates of occurrence of diabetes and its accompanying complications in Americans older than 65 by performing a longitudinal analysis of nationwide Medicare claims and other Medicare information.
Specifically, they looked for people first diagnosed with diabetes during 1994 (33,164 persons), 1999 (31,722) or 2003 (40,058). They compared them with 2 control groups, about the same size, who were not diagnosed with diabetes, either during 1994, 1999 or 2003, or for the entire period from 1994 to 1999 or from 1999 to 2004.
The main events they included in their analysis were deaths, and diabetes-related complications such as problems with eyes, kidneys, lower extremities, cardiovascular and cerebrovascular.
They found that:
The annual incidence of diabetes increased by 23 per cent between 1994-1995 and 2003-2004.
Prevalence increased by 62 per cent.
Surprisingly, the rate of death after diagnosis in people having diagnosed diabetes decreased by 8.3 per cent compared with that in the control groups.
Complication rates among people diagnosed with diabetes generally increased or stayed the same compared with those in the control groups during 1994 to 2004. The exception was diabetes-related eye diseases.
Rates for some major complications were high.
One example of this was the rate for congestive heart failure in the diabetes group during 1999 to 2004, which was 475 per 1000 persons.
In some cases, such as kidney problems, including the most serious complications, there were increases in prevalence in both the diabetes and control groups.
Sloan and colleagues concluded that:
"The burden of financing and providing medical care for persons older than 65 in the United States having diagnosed diabetes is growing rapidly as a result of increased incidence and, especially, prevalence of diagnosed diabetes, decreased mortality, and overall lack of improvement in rates of complications in persons having diagnosed diabetes."
They wrote that their findings emphasized the "overwhelming burden of diabetes, including the near 90 percent prevalence of an adverse outcome and many serious and resource-consuming outcomes such as coronary heart failure, myocardial infarction [heart attack] and stroke."
In an accompanying editorial in the same issue of the journal, Dr Frank Vinicor of the US Centers for Disease Control and Prevention (CDC) wrote that if these trends continue there won't be enough money to pay for individual treatment of diabetes patients.
The urgency to implement effective programs to prevent diabetes in older people has never been so acute.
"The Growing Burden of Diabetes Mellitus in the US Elderly Population."
Frank A. Sloan; M. Angelyn Bethel; David Ruiz, Jr; Alisa H. Shea; Mark N. Feinglos.
Arch Intern Med 2008;168(2):192-199.
Vol. 168 No. 2, January 28, 2008.
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