The new figures come as an expert panel urges
Congress to overhaul diabetes care and prevention, including recommendations to
move beyond a reliance on medical interventions alone. A report released
earlier this month calls for far broader policy changes to stem the diabetes
epidemic, such as promoting consumption of healthier foods, ensuring paid
maternal leave from the workplace, levying taxes on sugary drinks and expanding
access to affordable housing, among other areas.
In 2019, diabetes was the seventh-leading
cause of death in America and claimed more than 87,000 lives, reflecting a
long-running failure to address the illness and leaving many more vulnerable
when the COVID-19 pandemic hit, creating new hurdles to accessing care.
Since then, the nation’s toll from diabetes
has increased sharply, surpassing 100,000 deaths in each of the last two years
and representing a new record-high level, according to a Reuters analysis of
provisional death data compiled by the Centers for Disease Control and
Prevention (CDC). Diabetes-related deaths surged 17% in 2020 and 15% in 2021
compared to the prepandemic level in 2019. That excluded deaths directly
attributed to COVID-19. The CDC concurred with the Reuters analysis and said
additional deaths from 2021 are still being tallied.
“The large number of diabetes deaths for
a second year in a row is certainly a cause for alarm,” said Dr. Paul Hsu,
an epidemiologist at UCLA’s Fielding School of Public Health. “Type 2
diabetes itself is relatively preventable, so it’s even more tragic that so
many deaths are occurring.”
In a new report, the National Clinical Care
Commission created by Congress said that the United States must adopt a more
comprehensive approach to prevent more people from developing type 2 diabetes,
the most common form, and to help people who are already diagnosed avoid
life-threatening complications. About 37 million Americans, or 11% of the
population, have diabetes, and one in three Americans will develop the chronic
disease in their lifetime if current trends persist, according to the
commission.
“Diabetes in the US cannot simply be
viewed as a medical or health care problem, but also must be addressed as a
societal problem that cuts across many sectors, including food, housing,
commerce, transportation and the environment,” the commission wrote in its
Jan 5 report to Congress and the US Department of Health and Human Services
(HHS).
The federal panel recommended Congress create
an Office of National Diabetes Policy that would coordinate efforts across the
government and oversee changes outside health policy. It would be separate from
HHS and could be similar to the White House Office of National AIDS Policy,
according to Dr William Herman, commission chairman and a professor of internal
medicine and epidemiology at the University of Michigan.
“We aren’t going to cure the problem of
diabetes in the United States with medical interventions,” Herman told
Reuters. “The idea is to pull something together across federal agencies,
so they are systematically talking to one another.”
US Senator Patty Murray, a Democrat from
Washington who chairs the Senate health committee, helped create the commission
in 2017 and said she is studying the recommendations closely.
“People with diabetes and other chronic
illnesses were already facing challenges well before the pandemic hit, and
COVID has only made these problems worse,” Murray said in a statement to
Reuters. “It is absolutely crucial to research and find solutions to
better support diabetes patients and get them the care they need.”
MORE CASES, WORSE PROGNOSIS
As Reuters reported last year in a series,
diabetes represents a major public health failure in the United States. The
number of Americans with the disease has exploded in recent decades, and their
prognosis has worsened, even though spending on new treatments has soared.
The pandemic has proven especially deadly for
people with diabetes. People with poorly controlled diabetes have at least a
two-fold greater risk of death from COVID-19, according to the report. And
diabetes and its complications are more common in low-income Americans and
people of colour, longstanding disparities that were further exposed during the
pandemic.
Dr Shari Bolen, a commission member and an
associate professor of medicine at Case Western Reserve University and the
MetroHealth System in Cleveland, said the staggering number of diabetes deaths
is “disheartening but also a call to action.”
The federal panel’s report marked the first
such review on diabetes since 1975. During that time, the prevalence of
diabetes among US adults has increased from 5.3% in the late 1970s to 14.3% in
2018, it said. Direct medical costs related to diabetes were $237 billion in
2017, and there was an estimated $90 billion lost to lower productivity in the
United States.
High costs for doctor’s visits, medications
and supplies force many diabetes patients to forgo or delay routine care. Many
patients and US lawmakers have expressed outrage at the rising price of
insulin, which type 1 diabetes patients must take their entire lives and which
is sometimes required to keep type 2 patients’ disease under control. The
commission endorsed proposals such as capping insulin price increases to the
rate of inflation and government negotiation of drug prices.
Murray and other lawmakers have pushed for a
provision in the Biden administration’s proposed Build Back Better legislation
that would cap the cost of insulin at $35 for many patients.
To further ease financial barriers, the panel
recommended that patients’ out-of-pocket costs be waived for other
“high-value” treatments, including certain diabetes drugs, continuous
glucose monitors, basic supplies and diabetes education.
The commission also highlighted the risks of
overtreatment in older adults with type 2 diabetes. Reuters wrote about that
risk in November and how a drug industry campaign for an aggressive treatment
target led to an epidemic of potentially lethal incidents of low blood sugar,
or hypoglycemia. The panel asked federal health officials to track
overtreatment among Medicare patients to “reduce the incidence of severe
hypoglycemia and improve patient safety.”
The commission said the United States should
better promote the purchase of fruits and vegetables in food assistance
programs and ensure mothers have paid family leave to aid breastfeeding, which
can help reduce the risk of diabetes in mothers and is associated with a
reduced risk of obesity and diabetes in children. The panel also recommended
imposing taxes on sugary drinks that would raise their shelf price by 10% to
20% and using the revenue to expand access to clean drinking water and fund
similar programs.
HHS deferred comment to Herman. In a
statement, the CDC said the report’s recommendations offer a detailed roadmap
to “addressing rising health-care costs attributed to diabetes, and
reducing racial, ethnic, and income-related disparities in diabetes
outcomes.”
