Introduction: Diabetes in America

According to statistics released in 2017 by the Centers for Disease Control and Prevention (CDC),1 more than 30 million US children and adults have diabetes, 7.2 million of whom are undiagnosed. An estimated additional 84 million American adults have pre-diabetes as defined by one of three measures: a hemoglobin A1c of 5.7-6.4%, fasting plasma glucose of 100-125 mg/dL, or post-load glucose of 140-199 mg/dL--levels that are higher than normal but not sufficiently elevated to be diagnosed as diabetes.2 In 2015, approximately 1.5 million US adults aged 18 and older were newly diagnosed with diabetes.1 If current trends continue, it is possible that one in three US adults will be diagnosed with diabetes by 2050.3 The International Diabetes Federation (IDF) notes that three-quarters of the estimated 425 million people with diabetes worldwide are of working age (e.g., ages 20-64 years),4 suggesting an increased healthcare burden as these individuals age.

The IDF estimates that $727 billion dollars (12% of current global health expenditure) is spent on diabetes worldwide.4 The American Diabetes Association (ADA) has estimated that, in 2012, diagnosed diabetes cost $245 billion dollars (US) ($176 billion in direct medical costs plus $69 billion in reduced productivity), accounting for roughly one in five healthcare dollars spent.5 When undiagnosed diabetes, gestational diabetes, and pre-diabetes are included, the burden exceeds $322 billion-more than $1,000 for each American.6 People with diabetes incur, on average, annual medical expenditures of $13,700, of which nearly $8,000 is directly attributable to diabetes. Individuals with diagnosed diabetes incur medical expenses that are approximately 2.3 times higher than corresponding expenditures in the absence of diabetes.5

A major cause of heart disease and stroke, diabetes was the seventh leading cause of death in the US in 2015.1 The hyperglycemia that characterizes diabetes rarely occurs in isolation and often presents with a combination of other atherogenic abnormalities that affect cardiovascular health, such as dyslipidemias, hypertension, and obesity. Managing type 2 diabetes mellitus (T2DM) therefore requires an individualized, multi-faceted approach that includes behavioral modifications (usually in conjunction with pharmacotherapy) that require the patient to take an active role in managing his/her disease and its complications. The burgeoning global diabetes epidemic means that family physicians and other primary care physicians/clinicians should expect to manage T2DM patients of all ages and ethnic backgrounds, each of whom will have unique treatment considerations.

The New Jersey Academy of Family Physicians (NJAFP) assembled a panel of experts to integrate current evidence-based practices regarding the “ABCS” of diabetes management-A1c, Blood pressure, Cholesterol (lipids), and Smoking cessation-and create comprehensive, patient-centered diabetes management strategies that reduce cardiovascular risk. Family physicians, primary care physicians, and other primary care clinicians can, in turn, use these practices to engage patients in the management of their disease and lower their cardiovascular risk.

At a Glance

  • Type 2 diabetes mellitus (T2DM) is a progressive disorder that affects numerous organs and tissues.
  • Achieving and maintaining glycemic control is essential for managing diabetes and lowering the risk of its complications.
  • Management of T2DM is multi-faceted and involves behavioral modifications (nutrition therapy, physical activity, awareness of disease), often carried out in conjunction with pharmacotherapy.
  • Diabetes interventions should be individualized, use a treat-to-target approach, and involve the patient in the process of his/her disease management.
  • Comprehensive management strategies should incorporate the ABCS (e.g., A1c, blood pressure, cholesterol [lipid profiles], and smoking cessation) aimed at reducing cardiovascular risk.
  • Patients must be engaged in their care plan to minimize disease complications.
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