The Cost and Impact of Type 2 Diabetes: Policy Recommendations for a Growing Public Health Epidemic

The incidence of Type 2 diabetes has increased to 9.4% of the adult population, increasing by 1.5 million from 2016 to 2017. The Center for Disease Control and Prevention estimates that 23.1 million U.S. adults have been diagnosed with Type 2 diabetes, 7.3 million are diabetic but undiagnosed and 84.1 million have pre-diabetes and are at risk. Costs for treatment of those who are diagnosed increased to $322 billion in 2015, up 31% from $245 billion in 2013 and are expected to double in the next five years [1].

Public health officials attribute the increased incidence of Type 2 diabetes to many factors: heightened incidence of obesity and hypertension, decreased physical activity and changes in eating habits among them. Many with prediabetes are unaware they’re at risk; and among these, many are unwilling or unable to make lifestyle changes that might slow its progression to diagnosed Type 2 diabetes and its associated costs.

Reduction of the prevalence of Type 2 diabetes and its costs requires changes in eating habits and lifestyle changes to slow its severity for those already diagnosed and reduce its progression among persons with pre-diabetes. For those diagnosed and in treatment, medication and changes in eating habits have been the primary focus; for those with prediabetics, improvement in food choices and lifestyle changes have been encouraged, but public confusion about healthy diets and inability/unwillingness to make lifestyle changes have been problematic.

Policymakers and public health officials should take two immediate steps to address the problem: (1) The U.S. Dietary Guidelines should be updated to include food options (nutrition therapies) to address the heterogeneity of the prediabetic and Type 2 populations and provide evidence-based directives for consumers and their caregivers. (2) A public education campaign should be developed to educate consumers about the Dietary Guidelines and nutrition therapies to nullify nutritional advice that is misleading, contradictory and confusing.