The Burden of Diabetes 1 Worldwide Prevalence of

The Burden of Diabetes 1

Worldwide Prevalence of Diabetes Current estimated prevalence: 415 million worldwide By 2040, 642 million people worldwide are expected to have diabetes IDF. Diabetes Atlas Update 2015. Available at: http: //www. idf. org/sites/default/files/Atlas 7 e-poster. pdf. 2

Prevalence of Diabetes and Prediabetes in the United States 140 120 Undiagnosed DM Diagnosed DM Persons (millions) Prediabetes 7 100 8. 1 7. 2 21. 0 23. 1 86 84. 1 2014 2017 18. 8 80 60 Diabetes 9. 4% of US population 5. 7 17. 9 40 79 57 Prediabetes 34% of US population 20 0 2007 2011 CDC. National diabetes fact sheet, 2008. CDC. National diabetes fact sheet, 2011. CDC. National diabetes statistics report, 2014. CDC. National diabetes statistics report, 2017. https: //www. cdc. gov/diabetes/pdfs/data/statistics/national-diabetes-statisticsreport. pdf. 3

Projected Prevalence of Diabetes in the United States: 1990 to 2050 Undiagnosed Diagnosed Number (millions) 120 100 13. 7 80 13. 3 13. 1 60 12. 7 40 20 6. 6 0 19901 37. 9 12 7 21 20001 2010 2 20203 55. 5 20303 71. 2 20403 86. 6 2050 3 Year 1. National Diabetes Surveillance System. http: //www. cdc. gov/diabetes/statistics/prev/national/figpersons. htm. 2. CDC. National diabetes fact sheet, 2011. http: //www. cdc. gov/diabetes/pubs/pdf/ndfs_2011. pdf. 3. Boyle JP, et al. Popul Health Metr. 2010 Oct 22; 8: 29. 4

Prevalence of Diagnosed Diabetes in Different US Ethnic and Racial Groups US Adults ≥ 18 Years of Age Population (%) Men 18 16 14 12 10 8 6 4 2 0 Women 14. 9 15. 3 12. 6 8. 1 11. 7 12. 2 13. 2 9. 0 6. 8 7. 3 Non-Hispanic Asian American White Hispanic Non-Hispanic Native American Black CDC. National diabetes statistics report, 2017. https: //www. cdc. gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report. pdf 5

Annual Incidence of T 2 D in US Children and Adolescents SEARCH for Diabetes in Youth Age 10 -19 Years, 2012 Rate (per 100, 000 per year) 50 46. 5 40 32. 6 30 18. 2 20 12. 5 10 0 12. 2 3. 9 All Non. Hispanic white Mayer-Davis EJ, et al. N Engl J Med. 2017; 376: 1419 -1429. Non. Hispanic black Hispanic Asian or Pacific Islander Native American 6

T 2 D Prevalence Parallels Prevalence of Obesity Diagnosed Diabetes Obese 70 NHANES Data, U. S. Adults ≥ 20 Years 1 -5 Population (%) 60 12 CDC Data, U. S. Population 6, 7 Black women 8 40 Mexican American men Mexican American women Asian men 6 30 4 20 10 2 0 0 1980 1994 2000 2008 2010 2012 White women Black men 10 50 White men Asian women 19801994*2000 2008 2010 2012 2014 BMI, body mass index (in kg/m 2); CDC, Centers for Disease Control and Prevention; NHANES, National Health and Nutrition Examination Survey (x-axis lists last year of each survey). *NHANES 1994 data. 1. Flegal KM, et al. Int J Obes Relat Metab Disord. 1998; 22: 39 -47. 2. Flegal KM, et al. JAMA. 2002 ; 288: 1723 -1727. 3. Flegal KM, et al. JAMA. 2010; 303: 235 -241. 4. Flegal KM, et al. JAMA. 2012; 307: 491 -497. 5. Ogden CL, et al. JAMA. 2014; 311: 806 -814. 6. Harris MI, et al. Diabetes Care. 1998; 21: 518 -524. 7. CDC. Diabetes data & trends. Available at: https: //www. cdc. gov/diabetes/statistics/prev/national/figraceethsex. htm and http: //www. cdc. gov/diabetes/statistics/prev/national/fighispanicthsex. htm. 7

Increase in Diabetes Parallels the Increase in Obesity in the United States Diabetes Obesity* 12 111% increase 37. 7 27 18 17. 9 9 43% increase 9. 3 10 36 Population (%) 45 8 6. 5 6 4 2 0 0 1998 2014 *BMI ≥ 30 kg/m 2. CDC. National diabetes statistics report, 2014. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2014. Mokdad AH, et al. JAMA. 1999; 282: 1519 -1522; Mokdad AH, et al. Diabetes Care. 2000; 23: 1278 -1283; Flegal KM, et al. JAMA. 2016; 315: 2284 -2291. 8

Diabetes Morbidity and Mortality • 7 th leading cause of death in US • Leading cause of blindness • Most frequent cause of kidney failure • ~60% of nontraumatic lower limb amputations occur in people with diabetes • Diabetes also – Doubles the risk of periodontal disease – Doubles the risk of developing depression • Depression increases T 2 D risk by 60% – Increases patients’ susceptibility to acute illness (eg, pneumonia and influenza) • Worsens the prognosis of patients with acute illnesses CDC. National diabetes statistics report, 2017. https: //www. cdc. gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report. pdf. CDC. National diabetes statistics report, 2014. http: //www. cdc. gov/diabetes/pubs/statsreport 14/national-diabetes-report-web. pdf. CDC. National diabetes fact sheet, 2011. http: //www. cdc. gov/diabetes/pubs/pdf/ndfs_2011. pdf. 9

Diabetes and Morbidity and Mortality All-cause death 1. 5 CVD death 1. 7 Myocardial infarction Stroke 1. 45 1. 8 1. 55 1. 65 1. 75 Risk increase (relative to individuals without diabetes) CDC. National diabetes statistics report, 2014. http: //www. cdc. gov/diabetes/pubs/statsreport 14/nationaldiabetes-report-web. pdf 1. 85 10

Costs of Diabetes 2012 Burden Estimate 350 US Dollars (billions) 300 Indirect Direct $78 250 200 $69 150 $244 100 $176 50 0 Diagnosed *Includes $1. 3 billion in costs from gestational diabetes. Dall TM, et al. Diabetes Care. 2014; 37: 3172 -3179. $9 $23 $44 Undiagnosed Prediabetes Total* 11

Goal Achievement in Diabetes NHANES 2007 -2010* N=1444 Patients with diabetes (%) 100 90 80 79. 1 77. 7 70 56. 8 60 52. 2 50 40 N=1342 72 51. 4 51. 3 27. 5 30 20 14. 3 12. 6 10 0 <7 <8 >9 <70 <100 <130/80 A 1 C (%) LDL-C (mg/d. L) BP (mm/Hg) <140/90 Nonsmoker All goals met BP (mm/Hg) Taking a statin *Data from separate studies. BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Survey. Ali MK, et al. N Engl J Med. 2013; 368: 1613 -1624. Stark Casagrande S, et al. Diabetes Care. 2013; 36: 2271 -2279. 12

A 1 C Achievement by Individualized Target Patients with diabetes (%) NHANES 2007 -2010 (N=1444) Age (years) 100 90 80 70 60 50 40 30 20 10 0 Target A 1 C (%) 74. 6 69. 4 52. 0 57. 1 39. 4 37. 0 18 -44 45 -64 ≥ 65 ≤ 6. 5 ≤ 7. 0 ≤ 7. 5 ≤ 7. 0 ≤ 8. 0 Without complications With complications NHANES, National Health and Nutrition Examination Survey. Ali MK, et al. N Engl J Med. 2013; 368: 1613 -1624. 13