1. Peterson-Kaiser Health System Tracker How has diabetes care in the U.S. changed over time?

2. Peterson-Kaiser Health System Tracker Source: CDC/NCHS, National Vital Statistics System, Mortality Diabetes is among the 10 leading causes of death in the United States Age-adjusted death rates for the 10 leading causes of death per 100,000 population, United States, 2013

3. Peterson-Kaiser Health System Tracker Source: Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00540-en (Accessed on February 2, 2016). Note: Comparable countries are defined as those with above median GDP and above median GDP per capita in at least on of the past ten years. The mortality rate for diabetes in the U.S. rose between 1990-2002 but has been declining since 2003 Age-adjusted rates of diabetes mortality per 100,000 population

4. Peterson-Kaiser Health System Tracker Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Statistical analysis by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. Crude and age-adjusted rates of diagnosed diabetes have been steadily increasing Crude and age-adjusted rates of diagnosed diabetes per 100 civilian, non-institutionalized population

5. Peterson-Kaiser Health System Tracker Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Statistical analysis by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. Diagnosed diabetes has been increasing among people ages 45-74 Rates of diagnosed diabetes per 100 civilian, non-institutionalized population, by age

6. Peterson-Kaiser Health System Tracker Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Statistical analysis by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. Blacks and Hispanics have higher than average rates of diagnosed diabetes Age-adjusted rates of diagnosed diabetes per 100 civilian, non-institutionalized population, by race

7. Peterson-Kaiser Health System Tracker Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/global- burden-disease-study-2013-gbd-2013-data-downloads U.S. disease burden for endocrine diseases has increased nearly 15% in the past 2 decades Age-adjusted disability adjusted life years (DALYs) rate per 100,000 population, both sexes, 1990 and 2013

8. Peterson-Kaiser Health System Tracker Source: Information came from the CDC's Behavioral Risk Factor Surveillance System. The data were computed by CDC's Division of Diabetes Translation personnel.Behavioral Risk Factor Surveillance System Adults with diabetes have increasingly reported poor mental and physical health Percentage of adults aged 18 years or older with diabetes reporting poor mental health, poor physical health, poor mental or physical health, poor mental and physical health, and inability to do usual activities at least 1 day in the past 30 days, 2011

9. Peterson-Kaiser Health System Tracker Source: Information came from the CDC's Behavioral Risk Factor Surveillance System. The data was computed by CDC's Division of Diabetes Translation personnel.Behavioral Risk Factor Surveillance System From 1994-2010, the percent of diabetics receiving annual foot exams and self-monitoring blood glucose levels daily has increased Age-adjusted percentage of adults aged 18 years or older with diagnosed diabetes receiving: a dilated eye exam; foot exam; visiting a doctor for diabetes in the last year; and performing daily self-monitoring of blood glucose

10. Peterson-Kaiser Health System Tracker Rates of diabetes complications in the U.S. have decreased significantly from 1990-2010 Percent change in age-adjusted rates of diabetes complications among adults ages 20 and older with diagnosed diabetes, 1990 - 2010 Source: Adapted from Gregg EW, Li Y, Wang J, et al. “Changes in Diabetes-Related Complications in the United States, 1990-2010”, New England Journal of Medicine. 2014; 370:1514-1523. Notes: Numerators for rates of acute myocardial infarction, stroke, and amputation are from the National Hospital Discharge Survey. Numerators for rates of end-stage renal disease are from the U.S. Renal Data System, and numerators for death from hyperglycemic crisis are from the National Vital Statistics System. Denominators are from the National Health Interview Survey. Rates were age-standardized to the U.S. population in the year 2000.

11. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health quality indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on March 2, 2015). The U.S. hospitalization rate for uncontrolled diabetes is lower than in comparable countries, and higher for diabetes complications Age-adjusted hospital admission rate per 100,000 population, for uncontrolled diabetes, and diabetes short term complications, ages 15 and older, 2010

12. Peterson-Kaiser Health System Tracker Source: Data from the National Hospital Discharge Survey and the National Health Interview Survey, National Center for Health Statistics, Centers for Disease Control and Prevention. Data computed by personnel in CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Hospitalization for diabetic ketoacidosis is highest among those aged 0-44 Hospital discharge rates for Diabetic Ketoacidosis (DKA) as First Listed Diagnosis per 1,000 Diabetic Population, by Age

13. Peterson-Kaiser Health System Tracker Source: Data from the National Hospital Discharge Survey, National Center for Health Statistics, Centers for Disease Control and Prevention. Data computed by personnel in CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Average length of stay of hospital discharges with diabetes or diabetic ketoacidosis has been decreasing Average length of stay of Hospital Discharges with Diabetes as First Listed Diagnosis, in Days Average length of stay of Hospital Discharges with Diabetic Ketoacidosis (DKA) as First Listed Diagnosis, in Days

14. Peterson-Kaiser Health System Tracker Source: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Data analyzed by personnel in the CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Death rates for hyperglycemic crises have decreased among all age groups Death rates for hyperglycemic crises as underlying cause per 100,000 diabetic population

15. Peterson-Kaiser Health System Tracker Source: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Data analyzed by personnel in the CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. End-stage renal disease related to diabetes is highest among black men and women Age-adjusted incidence of end-stage renal disease related to Diabetes Mellitus per 100,000 diabetic population, by Race, Ethnicity, and Sex, 2008

16. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health quality indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on March 2, 2015). Notes: Data for 2006 Comparable Country Average are from 2007. Foot and leg amputations due to diabetes are decreasing in the U.S. and comparable countries Age-adjusted diabetes lower extremity amputation rate per 100,000 population, ages 15 and older, in years 2006, 2008, and 2010

17. Peterson-Kaiser Health System Tracker Source: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Data analyzed by personnel in the CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. More men than women with diabetes report using diabetes medication Percentage of adults aged 18 years or older with diagnosed diabetes reporting any diabetes medication use (pills, insulin, or both), all and by sex

18. Peterson-Kaiser Health System Tracker Some diabetes injectable prescription costs have increased between 77% and 380% from 2010 – 2015 Diabetes injectable prescription costs per mL, 2010 and 2015 Source: Alliance of Community Health Plans presentation “High –Cost Drugs: A CEO’s Perspective”, October 16, 2015. Notes: Presentation data on diabetes drug pricing based on Medispan AWP (August 2015)

19. Peterson-Kaiser Health System Tracker The monthly price of Glumetza tablets increased 500% in one year Glumetza prescription costs (1000 mg tablets), monthly (based on typical dose) Source: Alliance of Community Health Plans presentation “High –Cost Drugs: A CEO’s Perspective”, October 16, 2015. Notes: Presentation data on diabetes drug pricing based on Medispan AWP (August 2015)

20. Peterson-Kaiser Health System Tracker Source: “Penny-wise, pound-foolish: Association between Medication Adherence, Out-of-Pocket Expenses, and Health Care Costs in Medicare Patients with Type 2 Diabetes.” Abstract presented by Joanna P. MacEwan at the 74 th Scientific Session of the American Diabetes Association. Notes: For more information the abstract can be found here: http://app.core-apps.com/tristar-ada15/abstract/160858d53930b598d64b10f393081d64 Diabetic Medicare patients who are less adherent to prescribed medication have higher medical spending Pharmacy costs, medical expenditures, and total expenditures for Medicare beneficiaries ages 65 and older with type 2 diabetes mellitus, 2006-2009

21. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis Health Care Satellite Account (Blended Account) Note: Expenditures on nursing home and dental care are not included in health services spending by disease. Data last updated January 25, 2016. Endocrine diseases, including diabetes, are a leading driver of medical services spending growth from 2000-2012 Contribution to medical services expenditure growth, by disease, 2000-2012

22. Peterson-Kaiser Health System Tracker Source: Bureau of Economic Analysis Health Care Satellite Account (Blended Account) and National Health Expenditure Data Note: Spending on dental services, nursing homes, and prescriptions that cannot be allocated to a specific disease not included above. Data last updated January 25, 2016. Spending on endocrine diseases accounts for more than 7% of disease based health expenditures Total expenditures in US $ billions by disease category, 2012

23. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis Health Care Satellite Account (Blended Account) Note: Expenditures on nursing home and dental care are not included in health services spending by disease. Data last updated February 4, 2016. On a per capita basis, the U.S. spends about $440 per year to treat endocrine diseases, up from $192 in 2000 Per capita expenditures on the treatment of endocrine, nutritional, and metabolic diseases and immunity disorders, US $, 2000 - 2012

24. Peterson-Kaiser Health System Tracker Diagnosis with a serious or chronic health condition is associated with higher health spending Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services Average health spending per person based on diagnosis status, in U.S. Dollars, 2013

25. Peterson-Kaiser Health System Tracker People with a diagnosis of a serious or chronic health condition face higher average out-of-pocket costs Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services Average out-of-pocket spending per person based on diagnosis status, in U.S. Dollars, 2013