Medical Care Expenditures for Individuals with Prediabetes: The Potential Cost Savings in Reducing the Risk of Developing Diabetes

Abstract

The United States has 86 million adults with prediabetes. Individuals with prediabetes can prevent or delay the development of type 2 diabetes through lifestyle modifications such as participation in the National Diabetes Prevention Program (DPP), thereby mitigating the medical and economic burdens associated with diabetes. A cohort analysis of a commercially insured population was conducted using individual-level claims data from Truven Health MarketScan^® Lab Database to identify adults with prediabetes, track whether they develop diabetes, and compare medical expenditures for those who are newly diagnosed with diabetes to those who are not. This study then illustrates how reducing the risk of developing diabetes by participation in an evidence-based lifestyle change program could yield both positive net savings on medical care expenditures and return on investment (ROI). Annual expenditures are found to be nearly one third higher for those who develop diabetes in subsequent years relative to those who do not transition from prediabetes to diabetes, with an average difference of $2671 per year. At that cost differential, the 3-year ROI for a National DPP is estimated to be as high as 42%. The results show the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of type 2 diabetes.

Keywords: diabetes prevention program; lifestyle intervention; prediabetes; return on investment.

FIG. 1.

Study population. HbA1c <5.7% is normal; 5.7% to 6.4% is consistent with prediabetes, and >6.4% is consistent with diabetes. LOINC, logical observation identifiers names and codes.

FIG. 2.

Progression in average total medical care expenditures for individuals with diabetes diagnosis vs. no diabetes diagnosis, 1 to 3 years post HbA1c screening. These are averages for those who incurred a medical expense.

FIG. 3.

Average medical care expenditures for individuals with diabetes diagnosis vs. no diabetes diagnosis, 1 to 3 years post HbA1c screening. Only categories of medical care services with statistically significant differences are reported (P < 0.05). These are overall averages for those who incurred a medical expense within each category and do not capture average total expenses.

FIG. 4.

Average medical care expenditures for individuals with diabetes diagnosis vs. no diabetes diagnosis, cumulative total for 3 years post HbA1c screening. Only categories of medical care services with statistically significant differences are reported (P ≤ 0.05). These are overall averages for those who incurred a medical expense within each category and do not capture average total expenses.