Can Diabetes Bankrupt a Country?

Diabetes is not only expensive for those who have the disease, but it is also expensive for the government and countries that those people live in.

Currently, the worldwide cost of diabetes is 825 billion dollars per year. Unfortunately, that cost is only going to increase because diabetes is one of the fastest growing health problems in the world.

To put it in numbers, in the 1970’s, diabetes cost 1 billion dollars per year. The number increased to 116 billion in 2007, and is now more than 7 times that. It is estimated that by 2035, 600 million people will have diabetes and 90% of those patients will be diagnosed with type 2 diabetes, which is a preventable disease.

Why are the costs so high?

There are several complications related to diabetes that require treatment. Unfortunately, the treatments for those complications are not cheap.

Complications include:

• Kidney disease, which increases the cost of diabetes by 65% initially, and up to 195% when it gets worse. End stage renal disease increases costs by 771%.
• Heart disease or stroke, which increases the cost by 360%.
• High blood pressure, which increases the cost by 50% once you are on medications or have seen a cardiologist.
• Neuropathy
• Non-healing wounds or amputations
• Vision problems or even blindness

85% of the world’s diabetes budget is spent on complications, which is absurd.

That leaves little money for prevention or treatment before complications arise. With limited financial resources to help before major problems occur, complications caused by poorly treated diabetes are only going to increase in number and severity.

The cost of supplies and medications of treating diabetes are rising

Just like many other things in our world today, medications are also a for-profit business. For people with diabetes, this can drive up the cost of the drugs that they need by a lot. With diabetes on the rise, the price of diabetic medications is also increasing. This is known as supply and demand.

Let’s take insulin for example. There is a monopoly of the medication. Some brands of insulin, such as Levemir and Lantus, have increased their price in the past 5 years by more than 160%. In 1991, Medicaid paid pharmacies $6.86 per unit of insulin. In 2014, that cost increased to $15.38 per unit!

Luckily, many oral medications, such as Metformin, Glipizide, and Glyburide are pretty cheap. In the United States, they are all on the generic list where you can purchase a 30 day supply for $4 or a 90 day supply for $10. Unfortunately, these medications are not as helpful when diabetes becomes moderate to severe. At that stage, insulin is required to control blood sugar levels and prevent the expensive complications.

Let me tell you about a personal struggle that my family had with the cost of medications. When my grandmother was diagnosed with diabetes, she was already out of control. The doctor gave her the Novolog Flex pen because it was easy and convenient to use. There was no measuring, and the chance of having an inaccurate dosage was decreased.

Around October, they hit the dreaded “Donut Hole”, which meant that they had spent all their insurance’s allotted money, and they now had to cover for a large percentage of each medication themselves.

They tried to make it work for two months, but eventually, they couldn’t afford to pay their bills or even buy groceries. That led her to ration her insulin, which in turn decreased the efficacy of her treatment in order to keep her disease under control.

If the cost of your medications is too much, talk to your doctor about ways to reduce it. There is a good chance that your doctor does not know which insurance plan you have and the cost of all of your medications. The government really needs to intervene to help with this problem, but like previously mentioned, they are already spending too much of the budget on the complications.

It’s a terrible cycle that is very difficult to break. You don’t have the money to prevent it because you are spending it all on the people that are already really sick. So what happens? More people get really sick.

Complications can either kill you make your life miserable and difficult

The complications that can occur are not small and are expensive to treat. They are life-changing hurdles that can really decrease your quality of life and lead to an early death.

How do they cause you to suffer?

Let me explain some of the biggest ones.

• Kidney disease: If you develop end-stage renal disease, you can be placed on dialysis, which means that you must go to the doctor 3 times a week for several hours. This is where your body is cleansed of the things that your kidneys were getting rid of while they were still working properly.
• Stroke: This can leave you paralyzed on one side, or unable to swallow foods or talk. Many people cannot live at home by themselves after suffering from a stroke.
• Neuropathy: Not only is it painful, but it can make walking difficult.
• Amputations: This can cause you to be confined to a wheelchair, or have a difficult time getting around.
• Poor eye sight: Cataracts and vision problems can make doing everyday tasks such as driving or reading difficult.

Can this be prevented?

Type 2 diabetes, which makes up about 90% of those with diabetes, is preventable. Obesity is to blame for causing most cases of the disease. (On a side note, obesity costs Americans around 200 billion per year!) In the past 30 years, obesity rates have tripled. In the United States, ⅓ of adults and ⅙ of children are considered obese. At this rate of increase, by 2050, the number of people under 20 years old with diabetes is going to quadruple.

By following a healthy and active lifestyle, people can prevent or delay type 2 diabetes

Poor diet choices and lack of physical activity are two factors that cause obesity, which can lead to diabetes. Diet choices should include lots of fresh fruits and vegetables, whole grains, lean meats, fish, and low fat dairy products.

Water should also always be chosen over sugary sodas and juices. For more information on how to stick with a healthy diet, read the following article: https://www.thediabetescouncil.com/why-do-most-diets-fail/.

Exercise can be incorporated in several different ways in your life. Walking, swimming, dancing, or playing with your grandkids can all be great ways to increase your level of physical activity. Exercise is great for your entire body.

Be sure that you always talk to your doctor before beginning a new exercise program. If you need to, consult an exercise physiologist to create a great custom workout plan for you. Read more about how they can help you here: https://www.thediabetescouncil.com/can-exercise-physiologist-help-diabetes/.

Diabetes prevention education

Prevention is always the key when it comes to taking care of yourself. It is cheaper and easier to prevent a disease, than it is to wait until you get it and then try to treat it. What is upsetting is that many people don’t know how to prevent diabetes, or they don’t understand that it is not a reversible disease that you can get rid of like an infection.

Since this disease is threatening to bankrupt nations, it is also the responsibility of the government to help prevent its increase. There need to be better policies and guidelines put forward about the foods that we should eat, how to eat clean on a budget, and what is our food made of.

In the drive-thru world that we live in, the choices that we have to pick from are not entirely healthy. For example, it is much more expensive to eat a salad than it is to a hamburger and French fries. If you buy food at the grocery store, it is also more expensive to buy fresh foods than it is to choose those which are processed, full of sodium and empty calories.

We can learn a lot by looking at the school lunches in the United States. There are 30 million kids in the US that eat school lunches every day and 14 million that eat school breakfast provided by the school. In 2012, Congress changed the guidelines for school meals to provide healthier options with decreased sodium, more whole grains, and lots of veggies with fruits.

Currently, 98% of all school meal programs meet these standards, which is fantastic. By providing these healthy choices to children, it not only provides them with the appropriate nutrition, but it also introduces them to foods that they otherwise probably wouldn’t have the opportunity to have. If a system like this could be adapted by other food industries, consumers would then be a lot better off.

Another great way that you can help prevent diabetes from progressing is by meeting with a diabetes educator or a nutritionist in your area. Many insurance companies will pay for diabetes self-management training. Medicare Part B, for example, will pay for 10 hours which can provide you with adequate medication education, healthy eating and exercise counseling, as well as how to lower your risk and monitor your blood sugar.

We need better care for diabetes

As a healthcare worker, I feel like it is my responsibility to educate the patients that I come in contact with about their health. Doctors, case managers, and nurses all need to take responsibility and address things such as:

• Blood pressure
• Cholesterol
• Weight management
• Smoking status
• Poor diet
• Low physical activity

It is much easier to ignore the fact that a patient is overweight, smokes, and is making poor diet choices than it is to provide counseling on the effects that it may have in the future if they don’t change their habits. But ethically, it is not right.

If they are unable to make the necessary changes on their own or if they simply need a little more guidance, then providers need to refer patients to appropriate resources such as an exercise physiologist, dietician, diabetes educator, or any other helpful resource that they may find beneficial.

Let’s look at an example of a patient that I took care of recently. He was in to have a simple outpatient surgery, but his blood pressure was very high. After the surgery, while I was discharging the patient, I discovered that he had not been to a regular doctor in years, and that he hadn’t had his blood pressure checked in a while either.

I provided a list of physicians that were currently taking new patients, and educated him on the risk of high blood pressure and what it can do to your body. About 2 months later, the patient returned to have another simple surgery.

His blood pressure was 135/72, which is fantastic reading. He remembered me, and thanked me for “being pushy” and providing him all of that information. He was diagnosed with high blood pressure, and since he had started his medication, he felt a lot better.

It would have been easier for me to ignore the patient’s blood pressure and discharge him with just the instructions about his aftercare with this surgery. But it wouldn’t have been correct. Please listen to what your provider says, and even get a second opinion if you believe that they are incorrect.

Developing countries are also struggling

In developing countries, people are increasingly adapting the lifestyle of that of developed countries. People are not growing as many crops as they used to and they are eating less healthy. Also, sedentary lifestyles are taking over because hard labor is decreasing. These two factors together are causing an increase in type 2 diabetes and obesity.

In the Middle East, the rate of diabetes was 5.9% in 1980. In 2014, that number rose to 13.7%. In Africa, only 4 million people had the disease in 1980. That number jumped to 25 million in 2014. In these developing countries, insulin is not always available, and if is, it is very expensive, which means the lack of treatment for the disease is even greater and complications are much more common and severe.

Since these third world countries are already having a hard time financially, they are at a very high risk of going bankrupt if the disease is not prevented. Education levels are lower in these countries as well as means of communication, which makes providing educational teaching on how to prevent the disease even harder.

In developed countries, you can educate in schools, through television commercials, or at doctor’s offices. But how can you get that information out to people with limited access to healthcare, schools, or mass media platforms?

The UK Case

The National Health Service, which is the healthcare system for the United Kingdom, spends 10% of their total budget for primary care on diabetes alone. That equals out to $10 billion dollars per year.

It is estimated that this will increase to 17% of the total budget by 2025 for some countries in the UK. There was a recent scare that diabetes could bankrupt the NHS, which indirectly could affect UK’s economy.

What is the budget spent on? Medications are a small portion of the budget, using about 10%. More than 47.2 million medications were prescribed in 2014. A majority of the rest of the budget is spent on treating complications of diabetes.

They take up 80% of the budget. Last year, there were 135 amputations done per week in the UK, and 80% of them could have been avoided. These are very upsetting numbers.

What should the United Kingdom do to prevent bankruptcy? Just like the rest of the world, they need better prevention and treatment to prevent the complications. More than ⅓ of the patients with diabetes in England don’t receive the recommended care process that help prevent complications.

This is a huge problem. More people need to be receiving the appropriate care that can keep them healthy longer. The countries also need to emphasize educating people on ways to prevent diabetes and ways to treat it if you are diagnosed.

Other countries are struggling too. The United States spends 1 out of every 5 dollars on diabetes. With 24 million residents with diabetes, the total economic cost is $263 million a year. This cost includes sick days from work, disability, and the general healthcare costs associated with the disease.

Overall, diabetes is a very expensive disease that is causing problems for all countries, rich and poor. Many countries spend the majority of their budgets on treating complications, not on prevention. This is a problem because prevention can decrease the number in cases of diabetes.

If the number of diabetes related cases are low, the country does not have to spend its national health budget on treating diabetes or the complications that come with it.

TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on May 28, 2020

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