Type 2 Diabetes Complications Exact Heavy Tolls: AACE

Nearly a third of the estimated 18 million Americans with type 2 diabetes have chronic kidney disease, and about 20% have diabetic eye disease and foot problems, a surveillance report shows.  Microvascular and macrovascular complications from type 2 diabetes account for nearly $23 billion in direct medical costs, according to the report, titled State of Diabetes Complications in America, released by the American Association of Clinical Endocrinologists at its 2007 meeting here.

"On the national level, an estimated three out of five people with diabetes (57.9%) have one or more of the complications associated with diabetes," the report states. "These health problems are taking a heavy toll on the U.S. financially."
The report was developed by the AACE in partnership with the Amputee Coalition of America, the cardiac support group Mended Hearts, the National Federation of the Blind, and the National Kidney Foundation.

It melded data from the CDC’s National Health and Nutrition Examination Survey (NHANES) with medical expenditure information from the Agency for Health Care Research and Quality and the National Center for Health Statistics.
The purpose of the study was "to call attention to the issue of diabetes-related complications and bring about change in the way type 2 diabetes is managed in the U.S."

Among the report’s key findings:

• Estimated annual health care costs for a person with type 2 diabetes and related complications are $10,000, about $1,600 of which is out-of-pocket.
• Macrovascular complications of diabetes include myocardial infarction in 9.8%, angina/chest pain in 9.5% coronary heart disease in 9.1%, congestive heart failure in 7.9%, and stroke in 6.6%.
• Chronic kidney disease, the most prevalent complication of type 2 diabetes, affects an estimated 27.8% of those with the disease, compared with only 6.1% of those with normal glycemia. Diabetic foot problems affect 22.9%, and diabetic eye disease affects 18.9% of people with type 2 diabetes.
• In every category of microvascular and macrovascular complications, the estimated prevalence is higher among men then among women. For example, 30.4% of men with hyperglycemia have chronic kidney disease, compared with 25% of hyperglycemic women, and diabetic eye disease occurs in 20.3% of diabetic men, compared with 17.5% of diabetic women.
• The prevalence of most but not all complications is higher among non Hispanic blacks and Hispanics than non-Hispanic whites. For example, 24.5% of whites with diabetes have chronic kidney disease, compared with 35.2% of blacks, and 37.6% of Hispanics/Mexican Americans.
• Myocardial infarction is the costliest diabetes-associated complication, at $14,519 per case. Chronic kidney disease costs $9,002 per patient, followed closely by heart failure at $7,932 and stroke at $7,806 annually. Coronary heart disease drains $6,062 annually from health-care coffers, and diabetic eye disease accounts for $1,785.

American Association of Clinical Endocrinologists 2007 Annual Meeting: State of Diabetes Complications in America, American Association of Clinical Endocrinologists. Report released April 10.

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Anti-inflammatory drugs and diabetic retinopathy: Aspirin inhibits diabetic retinopathy in animals. The potential of three different salicylates to inhibit diabetes-induced degeneration of retinal capillaries in rats has now been tested. The results indicate that the salicylate-mediated inhibition of the degeneration of retinal capillaries and of the retinas of diabetic animals is mediated, at least in part, via inhibition of nuclear factor kappa B and the subsequent inflammatory response. Salicylates can be expected to provide further insights into the pathogenesis of diabetic retinopathy and to offer a basis for the development of even better therapies. Diabetes,56 (337-345): Zheng L, Howell S, Hatala D, Huang K, Kern T Salicylate-based anti-inflammatory drugs inhibit the early lesion of diabetic retinopathy