Projecting the Future Diabetes Population Size and Related Costs for the U.S.

  1. Elbert S. Huang, MD, MPH1,
  2. Anirban Basu, PHD1,
  3. Michael O'Grady, PHD2 and
  4. James C. Capretta, MA3
  1. 1Department of Medicine, University of Chicago, Chicago, Illinois;
  2. 2National Opinion Research Center at the University of Chicago, Chicago, Illinois;
  3. 3Civic Enterprises, Washington, DC.
  1. Corresponding author: Elbert S. Huang, ehuang{at}


OBJECTIVE We developed a novel population-level model for projecting future direct spending on diabetes. The model can be used in the federal budget process to estimate the cost implications of alternative policies.

RESEARCH DESIGN AND METHODS We constructed a Markov model simulating individuals' movement across different BMI categories, the incidence of diabetes and screening, and the natural history of diabetes and its complications over the next 25 years. Prevalence and incidence of obesity and diabetes and the direct spending on diabetes care and complications are projected. The study population is 24- to 85-year-old patients characterized by the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and National Health Interview Survey.

RESULTS Between 2009 and 2034, the number of people with diagnosed and undiagnosed diabetes will increase from 23.7 million to 44.1 million. The obesity distribution in the population without diabetes will remain stable over time with ∼65% of individuals of the population being overweight or obese. During the same period, annual diabetes-related spending is expected to increase from $113 billion to $336 billion (2007 dollars). For the Medicare-eligible population, the diabetes population is expected to rise from 8.2 million in 2009 to 14.6 million in 2034; associated spending is estimated to rise from $45 billion to $171 billion.

CONCLUSIONS The diabetes population and the related costs are expected to at least double in the next 25 years. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received March 9, 2009.
    • Accepted August 12, 2009.
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