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The Impact ofThe Impact ofDiabetes Mellitus in theDiabetes Mellitus in the
United StatesUnited States
Epidemiology, Costs, andEpidemiology, Costs, andFuture ProectionsFuture Proections
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Table of ContentsTable of Contents
SectionSection Slide No.Slide No.Epidemiology 3-28
Costs 29-37
Future Projections 38-43
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EPIDEMI!"!#$EPIDEMI!"!#$
Section Section
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Epidemiology of DiabetesEpidemiology of Diabetes
!i"#etes "$$ects 2%.8 million peopleo$ "ll "ges
8.3& o$ t'e (.S. popul"tion
!i"gnosed) 8.8 million
(ndi"gnosed) 7.* million
+e"ding c"use o$ ,idney $"ilurenontr"um"tic loer-lim# "mput"tion
ne c"ses o$ #lindness "mong "dults /"jor c"use o$ 'e"rt dise"se "nd stro,e
Se0ent' le"ding c"use o$ de"t'
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
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Diagnosed and UndiagnosedDiagnosed and UndiagnosedDiabetes in %&'&Diabetes in %&'&
.9 million people 52* ye"rs o$ "genely di"gnosed6 2%*** ere 2* ye"rs
$ t'e 2%. million :.3&; 52* ye"rs
/en) 3.* million :.8&;
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(acial)Ethnic Differences(acial)Ethnic Differencesin Diagnosed Diabetesin Diagnosed Diabetes
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
?"ceEt'nicity?"ceEt'nicity &&
Non-=isp"nic 'ites 7.
si"n meric"ns 8.4
=isp"nics+"tinosCu#"n meric"nsCentr"l "nd Sout' meric"ns/e@ic"n meric"nsPuerto ?ic"ns
.8 7. 7.3.33.8
Non-=isp"nic #l"c,s 2.
2**7A2**9 n"tion"l sur0ey d"t" $orpeople "ges 2* ye"rs or older
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Diagnosed and Undiagnosed DiabetesDiagnosed and Undiagnosed Diabetes
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
Source:2**%-2**8 N"tion"l =e"lt' "nd Nutrition E@"min"tion Sur0ey
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*e+ Cases of Diagnosed Diabetes*e+ Cases of Diagnosed Diabetes
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
Source:2**%-2**8 N"tion"l =e"lt' "nd Nutrition E@"min"tion Sur0ey estim"tes projected to t'e ye"r 2**
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.cdc.go0
County"e-el Estimates of DiagnosedCounty"e-el Estimates of DiagnosedDiabetes ./0, 1dults 2%& years, %&&3Diabetes ./0, 1dults 2%& years, %&&3
Percent
* A .%
. A 8.*
8. A 9.4
9.% A .
5 .2
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*umber of 1mericans +ith*umber of 1mericans +ithDiagnosed Diabetes, '43&%&&4Diagnosed Diabetes, '43&%&&4
.cdc.go0
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1nnual, 1ge1dusted Incidence (ate1nnual, 1ge1dusted Incidence (ateof Diagnosed Diabetes5, %&&6%&&7of Diagnosed Diabetes5, %&&6%&&7
MMWR. 2**86%7:43;)9-73.
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Pre-alence of !-er+eight and !besityPre-alence of !-er+eight and !besity1mong 1dults +ith Diabetes1mong 1dults +ith Diabetes
MMWR. 2**46%3:4%;)*-*8.
C!C "n"lysis o$ pre0"lence o$ o0ereig't"nd o#esity "mong (.S. "dults 52* ye"rsit' pre0iously di"gnosed di"#etes
0ereig't or o#esity) 8%.2&
#esity) %4.8&
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SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outhStudy !-er-ie+Study !-er-ie+
Popul"tion-#"sed o#ser0"tion"l study o$p'ysici"n-di"gnosed di"#etes "mongyout' 2* ye"rs o$ "ge
1niti"ted in 2***
Funded #y C!C N1= Collects d"t" $rom centers
4 geogr"p'ic"lly #"sed :Color"do 'io
Sout' C"rolin"
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379 yout' it' di"#etes in " popul"tiono$ 3.% million
0er"ge "ge "t di"gnosis) 8.4 ye"rs
0er"ge dur"tion o$ di"#etes)
% mont's :r"nge 38-* mont's; Estim"ted pre0"lence o$ (.S. yout' "ged
*-9 ye"rs it' di"#etes in 2**
.82 c"ses per *** yout':9%& C1) .78-.87 per *** yout';
C"ncer) .24 per ***st'm") 2* per ***
SE?C= $or !i"#etes in Bout' Study roup. Pediatrics. 2**68)%*-%8.
SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outh(esults(esults
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SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outh&4 $ears by (ace)Ethnicity&4 $ears by (ace)Ethnicity
SE?C= $or !i"#etes in Bout' Study roup. Pediatrics. 2**68)%*-%8.
N=
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SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outh'&'4 $ears by (ace)Ethnicity'&'4 $ears by (ace)Ethnicity
SE?C= $or !i"#etes in Bout' Study roup. Pediatrics. 2**68)%*-%8.
Pre-alence
N=
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SE1(C8 for Diabetes in $outhSE1(C8 for Diabetes in $outhPopulation Estimates, %&&'Population Estimates, %&&'
Estim"ted num#er o$ c"ses o$ di"#etesmellitus e@tr"pol"ted $rom SE?C= d"t"
%439 yout':9%& C1) %*489-%8248;
/"jority :78.7&; *-9 ye"rs o$ "ge Non-=isp"nic 'ite) 2& o$ t'ose 2*
ye"rs #ut 7& o$ "ll c'ildren it' di"#etes
328* c'ildren * ye"rs o$ "ge Non-=isp"nic 'ite) *& o$ popul"tion
#ut 77& o$ "ll c'ildren it' di"#etes
SE?C= $or !i"#etes in Bout' Study roup. Pediatrics. 2**68)%*-%8.
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PrediabetesPrediabetes
1n 2**%-2**8 #"sed on $"sting glucose or'emoglo#in C le0els predi"#etes "sdetected in
3%& o$ "dults "ges 2* ye"rs "nd older
%*& o$ "dults "ges % ye"rs "nd older
n estim"ted 79 million "dults "ges3* ye"rs "nd older
People it' predi"#etes '"0e "n incre"sedris, o$ de0eloping type 2 di"#etes 'e"rtdise"se "nd stro,e
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
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#estational Diabetes#estational Diabetes
?"nge $rom 2&A*& o$ pregn"ncies Postp"rtum %&A*& o$ omen it'
gest"tion"l di"#etes "re $ound to '"0edi"#etes usu"lly type 2
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Complications of DiabetesComplications of Diabetes
=e"rt dise"se "nd stro,e =ypertension
lindness eye pro#lems
?en"l dise"se Ner0ous system dise"se
mput"tions
!ent"l dise"se Complic"tions o$ pregn"ncy
t'er complic"tions
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
C li i f Di bC li ti f Di b t
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1n 2**4 o$ di"#etes-rel"ted de"t'certi$ic"tes "mong people "ges 5% ye"rs8& noted 'e"rt dise"se "nd & sto,e
dults it' di"#etes '"0e 'e"rt dise"se
de"t' r"tes 2A4 times 'ig'er t'"n t'oseit'out6 stro,e ris, is 2A4 times 'ig'er
1n 2**%-2**8 o$ "dults "ges 52* ye"rsit' sel$-reported di"#etes 7& '"d#lood pressure 54*9* mm=g or usedprescription medic"tions $or 'ypertension
Complications of DiabetesComplications of Diabetes8eart Disease, Stro9e, 8ypertension8eart Disease, Stro9e, 8ypertension
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
C li i f i bC li ti f Di b t
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!i"#etes is le"ding c"use o$ ne c"ses o$#lindness "mong "dults "ges 2*A74 ye"rs
$ people it' di"#etes "ged 54* ye"rs4.2 million :28.%&; '"d di"#etic
retinop"t'y in 2**%-2**8 %%*** :4.4& o$ t'ose it' di"#etes;
'"d "d0"nced di"#etic retinop"t'y t'"tcould le"d to se0ere 0ision loss
Complications of DiabetesComplications of Diabetes:lindness, Eye Problems:lindness, Eye Problems
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
C li i f Di bC li ti f Di b t
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1n 2**8 di"#etes "s le"ding c"use o$,idney $"ilure "ccounting $or 44& o$ "llne c"ses o$ ren"l $"ilure
48374 people it' di"#etes #eg"n
tre"tment $or end-st"ge ren"l dise"se:ES?!;
2*229* people it' ES?! due to di"#etesere li0ing on c'ronic di"lysis or it' ",idney tr"nspl"nt
Complications of DiabetesComplications of Diabetes(enal Disease(enal Disease
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
C li ti f Di b tC li ti f Di b t
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*&A7*& o$ people '"0e mild to se0ere$orms o$ ner0ous system d"m"ge 1mp"ired sens"tion or p"in in $eet
or '"nds
Sloed digestion o$ $ood in t'e stom"c' C"rp"l tunnel syndrome
Erectile dys$unction
Se0ere $orms "re " m"jor contri#utingc"use o$ loer-e@tremity "mput"tions)>*& occur in people it' di"#etes
Complications of DiabetesComplications of Diabetes*er-ous System Disease*er-ous System Disease
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
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Oral
medication
only58%
No
medication16%
Insulin only
12%
Insulin
and oral
medication14%
Treatment of DiabetesTreatment of Diabetes
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
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Deaths 1mong People +ith DiabetesDeaths 1mong People +ith Diabetes
1n 2**7 di"#etes se0ent' le"ding c"use o$de"t' #"sed on de"t' certi$ic"tes
7382 underlying c"use
**22 contri#uting c"use
+i,ely to #e underreported "s " c"useo$ de"t'
0er"ll ris, $or de"t' "mong t'ose it'
di"#etes is "#out tice t'"t o$ people it'simil"r "ge #ut it'out di"#etes
N"tion"l !i"#etes 1n$orm"tion Cle"ring'ouse. N"tion"l !i"#etes St"tistics 2*. 0"il"#le "t)'ttp)di"#etes.nidd,.ni'.go0dmpu#sst"tistics
1 Di t ib ti f D th1 Di t ib ti f D th
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1ge Distribution of Deaths1ge Distribution of Deaths1ssociated +ith Diabetes1ssociated +ith Diabetes
Age 70+206,71
7!%
Age "18
488
0%
Age 18#!4
1,181%
Age !5#44
5564
2%
Age 45#54
16,66!6% Age 55#51!,07
5%
Age 60#64
17,6!4
6%
Age 65#6
20,656
7%
meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%. Figure 4.
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C!STSC!STS
Section 2Section 2
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Economic Costs of Diabetes, %&&7Economic Costs of Diabetes, %&&7
Cost o$ !i"#etes /odel
ot"l cost o$ di"#etes) G74 #illion
G #illion) e@cess medic"le@penditures
G27 #illion to tre"t di"#etes directly
G%8 #illion to tre"t di"#etes-rel"tedc'ronic complic"tions "ttri#uted todi"#etes
G3 #illion e@cess medic"l costs
G%8 #illion) reduced n"tion"l producti0ity
meric"n !i"#etes ssoci"tion.Diabetes Care
. 2**863)%9-%.
Medical E pendit esMedical E;penditures
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Medical E;pendituresMedical E;penditures1ttributed to Diabetes, %&&71ttributed to Diabetes, %&&7
=ospit"l inp"tient c"re :%*&;
!i"#etes medic"tion "nd supplies :2&;
?et"il prescriptions to tre"t complic"tionso$ di"#etes :&;
P'ysici"n o$$ice 0isits :&;
meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%.
Costs Incurred by People +ith aCosts Incurred by People +ith a
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Costs Incurred by People +ith aCosts Incurred by People +ith aDiagnosis of Diabetes in %&&7Diagnosis of Diabetes in %&&7
0er"ge "nnu"l e@penditures) G744
G49 "ttri#uted to di"#etes
n "0er"ge people it' di"gnoseddi"#etes '"0e medic"l e@penditures 2.3
times 'ig'er t'"n t'ose it'out di"#etes G in G% 'e"lt' c"re doll"rs is spent
c"ring $or someone it' di"gnoseddi"#etes
G in G* 'e"lt' c"re doll"rs is"ttri#uted to di"#etes
meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%.
8ealth (esource Use8ealth (esource Use
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8ealth (esource Use8ealth (esource Use1ttributed to Diabetes, %&&71ttributed to Diabetes, %&&7
meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%. "#le %.
=e"lt' resource=e"lt' resource
ge :ye"rs;ge :ye"rs;
ot"lHot"lH4%4% 4%-44%-4 55%%
Institutional care
=ospit"l inp"tient d"ysNursingresidenti"l $"cilityd"ys
2%29
7%8*3
4%24387
2422%*%9
Outpatient care
$$ice-#"sed p'ysici"n 0isitsEmergency 0isits=ospit"l outp"tient "nd
$reest"nding "m#ul"tory
surgic"l center 0isits=ome 'e"lt' 0isits=ospice c"re d"ys?et"il prescriptions
73%34993*7
*4
%8
2%%29842%3%
893922
729%
3*8*82*84888
8449%
8884
473%%7%73*
2738892
7%37
HNum#ers do not necess"rily sum to tot"ls #ec"use o$ rounding
Indirect CostsIndirect Costs
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Indirect CostsIndirect Costs1ttributed to Diabetes, %&&71ttributed to Diabetes, %&&7
meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%. "#le 4.
Cost componentCost component Producti0ity lossProducti0ity loss
ot"l costot"l cost
"ttri#ut"#le"ttri#ut"#le
to di"#etesto di"#etes
:G #illions;:G #illions;
ProportionProportion
o$ indirecto$ indirect
costs :&;costs :&;
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Mortality CostsMortality Costs1ttributed to Diabetes, %&&71ttributed to Diabetes, %&&7
meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%. "#le .
Prim"ry c"usePrim"ry c"use
o$ de"t'o$ de"t'ot"l (Sot"l (S
de"t'sde"t's
!e"t's "ttri#uted to di"#etes!e"t's "ttri#uted to di"#etes
!e"t's!e"t's
& o$& o$
tot"ltot"l
o$ (So$ (S
de"t'sde"t's
I"lue o$I"lue o$
lostlost
producti0ityproducti0ity
:millions o$:millions o$
doll"rs;doll"rs;
!i"#etes 77*** 77*** **.* 9%2*
?en"l dise"se 43*** 2%*** %7.4 2
Cere#ro0"scul"rdise"se
%%*** %9*** 37. 3849
C"rdio0"scul"rdise"se 739*** 23*** .% 47
ot"lot"l NHNH 284***284*** NHNH 29*229*2
Hot"l comprises mort"lity $or re"sons ot'er t'"n t'ose listed 'ere
Economic Costs of PrediabetesEconomic Costs of Prediabetes
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Economic Costs of PrediabetesEconomic Costs of Prediabetesand Diabetes, %&&7and Diabetes, %&&7
=ig'er medic"l costs) G%3 #illion
Producti0ity loss) G% #illion
ot"l cost) G28 #illionJ
G74.4 #illion $or di"gnosed di"#etes
G8 #illion $or undi"gnosed di"#etes
G2% #illion $or predi"#etes
G3 million $or gest"tion"l di"#etes
ot"l #urden $or e"c' meric"n reg"rdlesso$ di"#etes st"tus) G7** "nnu"lly
!"ll / et "l. Health Affairs. 2**629:2;)297-3*3.
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(educing the :urden of Diabetes(educing the :urden of Diabetes
urden o$ di"#etes complic"tions onindi0idu"ls 'e"lt' c"re system signi$ic"nt
/uc' o$ t'e cost is pre0ent"#le t'roug'
1mpro0ed diet "nd e@ercise
Pre0ention initi"ti0es to reducepre0"lence o$ di"#etes comor#idities
1mpro0ed c"re $or people it' di"#etesto reduce need $or costly complic"tions
(nderst"nding economic cost m"jordetermin"nts o$ costs c"n 'elp in$ormmoti0"te decisions to reduce #urden
meric"n !i"#etes ssoci"tion. Diabetes Care. 2**863)%9-%.
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FUTU(E P(!
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IDF Diabetes Atlas 4t'ed. K1ntern"tion"l !i"#etes Feder"tion 2**9.
IDF #lobal Proections for *umber ofIDF #lobal Proections for *umber ofPeople +ith Diabetes, %&'&%&=&People +ith Diabetes, %&'&%&=&
Estimated *umber of People +ithEstimated *umber of People +ith
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Estimated *umber of People +ithEstimated *umber of People +ithDiabetes >orld+ide, %&'& and %&=&Diabetes >orld+ide, %&'& and %&=&
IDF Diabetes Atlas 4t'ed. K1ntern"tion"l !i"#etes Feder"tion 2**9.
CountryerritoryCountryerritory2**2**
/illions/illions CountryerritoryCountryerritory2*3*2*3*
/illions/illions
1ndi" %*.8 1ndi" 87.*
2 C'in" 43.2 2 C'in" 2.
3 (S 2.8 3 (S 3.*
4 ?ussi"n Feder"tion 9. 4 P",ist"n 3.8% r"Lil 7. % r"Lil 2.7
erm"ny 7.% 1ndonesi" 2.*
7 P",ist"n 7. 7 /e@ico .9
8 M"p"n 7. 8 "ngl"des' *.49 1ndonesi" 7.* 9 ?ussi"n Feder"tion *.3
* /e@ico .8 * Egypt 8.
Modeling the Future U S :urden ofModeling the Future U S :urden of
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Modeling the Future U?S? :urden ofModeling the Future U?S? :urden ofDiabetes Through %&6&Diabetes Through %&6&
Constructed system o$ dyn"mic eu"tions
1niti"l pre0"lence :percent"ge o$popul"tion it' di"gnosedundi"gnoseddi"#etes;
1ncidence :percent"ge o$ popul"tionit' nely di"gnosed di"#etes;
/igr"tion
/ort"lity
Pre0"lence o$ predi"#etes Eu"tions used to model $uture #urden o$
di"#etes on (.S. "dults t'roug' 2*%*
oyle MP et "l. Popul Health Metr. 2**68)29.
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1nnual U?S? Diabetes :urden in %&6&1nnual U?S? Diabetes :urden in %&6&
y 2*%* pre0"lence o$ tot"l di"#etes:di"gnosed "nd undi"gnosed; is projectedto incre"se $rom in * "dults to #eteen in % "nd in 3 "dults
1ncidence) $rom 8 in *** to % in *** +"rgely "ttri#uted to t'ree ,ey $"ctors
ging o$ t'e (.S. popul"tion
1ncre"sing siLe o$ 'ig'er-ris, minoritypopul"tions
!eclining mort"lity "mong t'ose it'di"#etes
oyle MP et "l. Popul Health Metr. 2**68)29.
Total U S 1dult PopulationTotal U S 1dult Population
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oyle MP et "l. Popul Health Metr. 2**68)29.
Total U?S? 1dult PopulationTotal U?S? 1dult PopulationDiabetes Pre-alence ProectionsDiabetes Pre-alence Proections