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 The new figures come as an expert panel urges Congress to overhaul
diabetes care and prevention, including recommendations to move
beyond a reliance on medical interventions alone. A report released
earlier this month calls for far broader policy changes to stem the
diabetes epidemic, such as promoting consumption of healthier foods,
ensuring paid maternal leave from the workplace, levying taxes on
sugary drinks and expanding access to affordable housing, among
other areas.
In 2019, diabetes was the seventh-leading cause of death in America
and claimed more than 87,000 lives, reflecting a long-running
failure to address the illness and leaving many more vulnerable when
the COVID-19 pandemic hit, creating new hurdles to accessing care.
Since then, the nation’s toll from diabetes has increased sharply,
surpassing 100,000 deaths in each of the last two years and
representing a new record-high level, according to a Reuters
analysis of provisional death data compiled by the Centers for
Disease Control and Prevention (CDC). Diabetes-related deaths surged
17% in 2020 and 15% in 2021 compared to the prepandemic level in
2019. That excluded deaths directly attributed to COVID-19. The CDC
concurred with the Reuters analysis and said additional deaths from
2021 are still being tallied.
"The large number of diabetes deaths for a second year in a row is
certainly a cause for alarm," said Dr. Paul Hsu, an epidemiologist
at UCLA's Fielding School of Public Health. "Type 2 diabetes itself
is relatively preventable, so it's even more tragic that so many
deaths are occurring."
In a new report, the National Clinical Care Commission created by
Congress said that the United States must adopt a more comprehensive
approach to prevent more people from developing type 2 diabetes, the
most common form, and to help people who are already diagnosed avoid
life-threatening complications. About 37 million Americans, or 11%
of the population, have diabetes, and one in three Americans will
develop the chronic disease in their lifetime if current trends
persist, according to the commission.
"Diabetes in the U.S. cannot simply be viewed as a medical or health
care problem, but also must be addressed as a societal problem that
cuts across many sectors, including food, housing, commerce,
transportation and the environment," the commission wrote in its
Jan. 5 report to Congress and the U.S. Department of Health and
Human Services (HHS).
The federal panel recommended Congress create an Office of National
Diabetes Policy that would coordinate efforts across the government
and oversee changes outside health policy. It would be separate from
HHS and could be similar to the White House Office of National AIDS
Policy, according to Dr. William Herman, commission chairman and a
professor of internal medicine and epidemiology at the University of
Michigan.
"We aren’t going to cure the problem of diabetes in the United
States with medical interventions," Herman told Reuters. "The idea
is to pull something together across federal agencies, so they are
systematically talking to one another."
U.S. Senator Patty Murray, a Democrat from Washington who chairs the
Senate health committee, helped create the commission in 2017 and
said she is studying the recommendations closely.
"People with diabetes and other chronic illnesses were already
facing challenges well before the pandemic hit, and COVID has only
made these problems worse," Murray said in a statement to Reuters.
"It is absolutely crucial to research and find solutions to better
support diabetes patients and get them the care they need."
MORE CASES, WORSE PROGNOSIS
As Reuters reported last year in a series, diabetes represents a
major public health failure in the United States. The number of
Americans with the disease has exploded in recent decades, and their
prognosis has worsened, even though spending on new treatments has
soared.
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 The pandemic has proven especially deadly for
people with diabetes. People with poorly
controlled diabetes have at least a two-fold
greater risk of death from COVID-19, according
to the report. And diabetes and its
complications are more common in low-income
Americans and people of color, longstanding
disparities that were further exposed during the
pandemic.
Dr. Shari Bolen, a commission member and an
associate professor of medicine at Case Western
Reserve University and the MetroHealth System in
Cleveland, said the staggering number of
diabetes deaths is "disheartening but also a
call to action."
The federal panel's report marked the first such
review on diabetes since 1975. During that time,
the prevalence of diabetes among U.S. adults has
increased from 5.3% in the late 1970s to 14.3%
in 2018, it said. Direct medical costs related
to diabetes were $237 billion in 2017, and there
was an estimated $90 billion lost to lower
productivity in the United States.
High costs for doctor's visits, medications and
supplies force many diabetes patients to forgo
or delay routine care. Many patients and U.S.
lawmakers have expressed outrage at the rising
price of insulin, which type 1 diabetes patients
must take their entire lives and which is
sometimes required to keep type 2 patients’
disease under control. The commission endorsed
proposals such as capping insulin price
increases to the rate of inflation and
government negotiation of drug prices.
Murray and other lawmakers have pushed for a
provision in the Biden administration's proposed
Build Back Better legislation that would cap the
cost of insulin at $35 for many patients.
To further ease financial barriers, the panel
recommended that patients’ out-of-pocket costs
be waived for other "high-value" treatments,
including certain diabetes drugs, continuous
glucose monitors, basic supplies and diabetes
education.
The commission also highlighted the risks of
overtreatment in older adults with type 2
diabetes. Reuters wrote about that risk in
November and how a drug industry campaign for an
aggressive treatment target led to an epidemic
of potentially lethal incidents of low blood
sugar, or hypoglycemia. The panel asked federal
health officials to track overtreatment among
Medicare patients to "reduce the incidence of
severe hypoglycemia and improve patient safety."
The commission said the United States should
better promote the purchase of fruits and
vegetables in food assistance programs and
ensure mothers have paid family leave to aid
breastfeeding, which can help reduce the risk of
diabetes in mothers and is associated with a
reduced risk of obesity and diabetes in
children. The panel also recommended imposing
taxes on sugary drinks that would raise their
shelf price by 10% to 20% and using the revenue
to expand access to clean drinking water and
fund similar programs.
 HHS deferred comment to Herman. In a statement,
the CDC said the report's recommendations offer
a detailed roadmap to "addressing rising
health-care costs attributed to diabetes, and
reducing racial, ethnic, and income-related
disparities in diabetes outcomes."
(Reporting by Chad Terhune and Robin Respaut;
Editing by Daniel Wallis)
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