OBJECTIVE -To project the number of people with diagnosed diabetes in the U.S. through 2050, accounting for changing demography and diabetes prevalence rates.RESEARCH DESIGN AND METHODS -We combined age-, sex-, and race-specific diagnosed diabetes prevalence rates-predicted from 1980 -1998 trends in prevalence data from the National Health Interview Survey-with Bureau of Census population demographic projections. Sensitivity analyses were performed by varying both prevalence rate and population projections.RESULTS -The number of Americans with diagnosed diabetes is projected to increase 165%, from 11 million in 2000 (prevalence of 4.0%) to 29 million in 2050 (prevalence of 7.2%). The largest percent increase in diagnosed diabetes will be among those aged Ն75 years (ϩ271% in women and ϩ437% in men). The fastest growing ethnic group with diagnosed diabetes is expected to be black males (ϩ363% from 2000 -2050), with black females (ϩ217%), white males (ϩ148%), and white females (ϩ107%) following. Of the projected 18 million increase in the number of cases of diabetes in 2050, 37% are due to changes in demographic composition, 27% are due to population growth, and 36% are due to increasing prevalence rates.CONCLUSIONS -If recent trends in diabetes prevalence rates continue linearly over the next 50 years, future changes in the size and demographic characteristics of the U.S. population will lead to dramatic increases in the number of Americans with diagnosed diabetes.

OBJECTIVE—The purpose of this study was to examine whether glycemic control has improved in recent years among individuals with diagnosed diabetes. RESEARCH DESIGN AND METHODS—We examined trends in A1C levels for adults with diagnosed diabetes using three consecutive waves of the National Health and Nutrition Examination Survey (NHANES): 1999–2000, 2001–2002, and 2003–2004. We estimated mean A1C levels and the proportion with A1C <7.0, <8.0, and <9.0%. We used multivariate regression to test whether A1C levels differed by NHANES wave after controlling for other factors. Multivariate dichotomous logistic regression and predictive margins were used to test whether the percentages of individuals with diabetes in selected A1C intervals differed by NHANES wave. RESULTS—Mean A1C levels among individuals with diagnosed diabetes declined from 7.82% in 1999–2000 to 7.47 and 7.18% in 2001–2002 and 2003–2004, respectively. After controlling for demographics and diabetes duration, A1C levels were 0.308 (P = 0.20) and 0.511 (P = 0.03) percentage points lower in 2001–2002 and 2003–2004, respectively, than in 1999–2000. The logistic results indicated corresponding improvements over time: the predictive margin for having A1C <7.0% increased from 37.0% in 1999–2000 to 49.7% in 2001–2002 and to 55.7% in 2003–2004. CONCLUSIONS—Glycemic control improved between 1999 and 2004. This trend may represent an important improvement in diabetes care and is encouraging for future reduction of diabetes-related complications.

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Estimates of the medical costs associated with different stages of CKD are needed to assess the economic benefits of interventions that slow the progression of kidney disease. We combined laboratory data from the National Health and Nutrition Examination Survey with expenditure data from Medicare claims to estimate the Medicare program's annual costs that were attributable to CKD stage 1-4. The Medicare costs for persons who have stage 1 kidney disease were not significantly different from zero. Per person annual Medicare expenses attributable to CKD were $1700 for stage 2, $3500 for stage 3, and $12,700 for stage 4, adjusted to 2010 dollars. Our findings suggest that the medical costs attributable to CKD are substantial among Medicare beneficiaries, even during the early stages; moreover, costs increase as disease severity worsens. These cost estimates may facilitate the assessment of the net economic benefits of interventions that prevent or slow the progression of CKD.

OBJECTIVETo analyze the cost-effectiveness of bariatric surgery in severely obese (BMI ≥35 kg/m2) adults who have diabetes, using a validated diabetes cost-effectiveness model.RESEARCH DESIGN AND METHODSWe expanded the Centers for Disease Control and Prevention–RTI Diabetes Cost-Effectiveness Model to incorporate bariatric surgery. In this simulation model, bariatric surgery may lead to diabetes remission and reductions in other risk factors, which then lead to fewer diabetes complications and increased quality of life (QoL). Surgery is also associated with perioperative mortality and subsequent complications, and patients in remission may relapse to diabetes. We separately estimate the costs, quality-adjusted life-years (QALYs), and cost-effectiveness of gastric bypass surgery relative to usual diabetes care and of gastric banding surgery relative to usual diabetes care. We examine the cost-effectiveness of each type of surgery for severely obese individuals who are newly diagnosed with diabetes and for severely obese individuals with established diabetes.RESULTSIn all analyses, bariatric surgery increased QALYs and increased costs. Bypass surgery had cost-effectiveness ratios of $7,000/QALY and $12,000/QALY for severely obese patients with newly diagnosed and established diabetes, respectively. Banding surgery had cost-effectiveness ratios of $11,000/QALY and $13,000/QALY for the respective groups. In sensitivity analyses, the cost-effectiveness ratios were most affected by assumptions about the direct gain in QoL from BMI loss following surgery.CONCLUSIONSOur analysis indicates that gastric bypass and gastric banding are cost-effective methods of reducing mortality and diabetes complications in severely obese adults with diabetes.

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Objective-To estimate the economic burden of vision loss and eye disorders in the United States population younger than 40 years in 2012.Design-Econometric and statistical analysis of survey, commercial claims, and census data. Participants-The United States population younger than 40 years in 2012.Methods-We categorized costs based on consensus guidelines. We estimated medical costs attributable to diagnosed eye-related disorders, undiagnosed vision loss, and medical vision aids using Medical Expenditure Panel Survey and MarketScan data. The prevalence of vision impairment and blindness were estimated using National Health and Nutrition Examination Survey data. We estimated costs from lost productivity using Survey of Income and Program Participation. We estimated costs of informal care, low vision aids, special education, school screening, government spending, and transfer payments based on published estimates and federal budgets. We estimated quality-adjusted life years (QALYs) lost based on published utility values. Main Outcome Measures-Costs and QALYs lost in 2012.Results-The economic burden of vision loss and eye disorders among the United States population younger than 40 years was $27.5 billion in 2012 (95% confidence interval, $21.5-$37.2 billion), including $5.9 billion for children and $21.6 billion for adults 18 to 39 years of age. Direct costs were $14.5 billion, including $7.3 billion in medical costs for diagnosed disorders, Correspondence: John S. Wittenborn, BS, National Opinion Research Center, University of Chicago, 1981 Grace Point Road, Morrisville, NC 27560. wittenborn-john@norc.org; JohnSWittenborn@gmail.com. * A complete listing of the Vision Cost-effectiveness Study Group is available at http://aaojournal.org. * Group members listed online in Appendix 1 (available at http://aaojournal.org). Financial Disclosure(s):The author(s) have no proprietary or commercial interest in any materials discussed in this article. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript $4.9 billion in refraction correction, $0.5 billion in medical costs for undiagnosed vision loss, and $1.8 billion in other direct costs. Indirect costs were $13 billion, primarily because of $12.2 billion in productivity losses. In addition, vision loss cost society 215 000 QALYs.Conclusions-We found a substantial burden resulting from vision loss and eye disorders in the United States population younger than 40 years, a population excluded from previous studies.Monetizing quality-of-life losses at $50 000 per QALY would add $10.8 billion in additional costs, indicating a total economic burden of $38.2 billion. Relative to previously reported estimates for the population 40 years of age and older, more than one third of the total cost of vision loss and eye disorders may be incurred by persons younger than 40 years.Disorders of the eye and resulting vision loss impose a significant burden on the United States, both economically and socially. In addition to medical costs, the debili...

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