The cost of diabetes.

• Author: Graham, Timothy
• Position: America's next public health crisis?

Y ou've heard the old cliche before: "This is just the tip of the iceberg."

In the case of diabetes the old saying couldn't be more true. The numbers are staggering. Diabetes sits atop a pyramid of medical problems with overweight and obesity at its base (70% of US adults), prediabetes in the middle (40% of US adults), and diabetes at the peak (9% of US adults). Diabetes cuts life short for many--and for businesses results in dramatically higher health care costs. Today almost 50% of adults in the U.S. either suffer from diabetes or prediabetes. Prediabetes is a state of elevated blood glucose levels that precedes diabetes by several years, and which by itself dramatically increases the risk of developing costly medical problems like heart disease, stroke, and several forms of cancer.

A single employee who requires kidney dialysis as a consequence of diabetes can cost a health plan more than $100,000 per year. With increasing numbers of employers opting to self-insure employees for their medical coverage, just a single employee affected with a complication of diabetes could be financially devastating.

As a result, some business owners are already taking action. According to a recent RAND Employer Survey, approximately half of U.S. businesses offer employee wellness initiatives that target obesity and diabetes. These often involve positive financial incentives for employee participation and can range from simple offerings like sponsoring memberships to local gyms, to more complex offerings like organized health risk assessments (HRA), biometric screenings (such as BMI and waist measurements), and laboratory testing. Businesses are increasingly expecting real returns on their investments, with a growing trend to reward employees not only for participation but for their successes in improving their health, changes that will ultimately reduce cost of their medical coverage and care.

Seeing these changes, University of Utah Health Care completely changed the way we deliver care for patients at-risk for diabetes. In 2014 we launched a new prevention program, which utilizes the newest testing methods, including cutting-edge "biomarker" bloodwork, that makes it possible to assess risk factors in greater detail so that diet, exercise and medical treatments can be tailored to individual needs. In collaboration with the University of Utah College of Health, we created...