16 Diabetic retinopathy is another frequent complication present in almost 20% of patients at the time of their diabetes diagnosis, with another 40% to 45% of persons with diabetes developing it over their disease course. 15 CV morbidity and mortality among people with diabetic kidney disease is 20 to 40 times higher compared with persons with diabetes without nephropathy. 1ĭiabetic kidney disease is a microvascular complication of T1D and T2D occurring in 30% to 40% of patients and is a major contributor to mortality in diabetes. 14 A multifactorial approach (glycemic/hypertension/dyslipidemia management and use of agents with CV and renal benefits) where risk factors are addressed simultaneously is strongly recommended to improve CV outcomes among persons with diabetes. CV risk factors should always be assessed in patients with diabetes (at minimum annually), including duration of diabetes, obesity or overweight, hypertension, dyslipidemia, smoking, family history of ASCVD, CKD, and albu-minuria (a marker of inflammation).
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There is significant evidence showing the benefits of controlling CV risk factors to slow the onset and/or progression of ASCVD among persons with diabetes. 12,13Ītherosclerotic CV disease (ASCVD), including coronary heart disease, cerebrovascular disease, and peripheral arterial disease, is the leading cause of morbidity and mortality in persons with diabetes. Fortunately, with proper care and preventive measures, most complications can be delayed or avoided, allowing affected patients to live longer and healthier lives. 12 Other acute issues such as hypoglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar state, and hyperglycemic diabetic comas can also occur. 1,11Ĭomorbidities and complications of diabetes include cardiovascular (CV) disease, chronic kidney disease (CKD), neuropathy, dental caries, diabetic foot problems, mental health problems, hearing loss, and macular degeneration, a severe form of diabetic retinopathy leading to vision loss. 1,11 For example, smoking, weight, physical inactivity, high blood pressure, high cholesterol, and A1C can be modified to delay or prevent the progression of diabetes-related complications. 1 Approximately 90% of all persons with diabetes in the United States have insulin resistance (type 2 diabetes ) in which modifiable risk factors exist, whereas the remaining 10% have autoimmune or type 1 diabetes (T1D). 8īecause diabetes is a complex, chronic illness, multiple strategies are necessary to decrease risks in addition to glycemic control. 10 An estimated 96 million adults 18 years or older had prediabetes in 2019, and 48.8% of that population is over the age of 65.
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9 Significant racial and ethnic disparities still exist, with the prevalence of diagnosed diabetes in 2019 having been the highest in American Indian/Alaskan Native (14.5%), non-Hispanic Black (12.1%), and Hispanic (11.8%) individuals compared with non-Hispanic Asian (9.5%) and non-Hispanic White (7.4%) individuals. 8 By 2050, 1 in 3 Americans will be diagnosed with diabetes during their life-time. The Centers for Disease Control and Prevention estimated that in 2019, 11.3% of the US population (37.3 million people) had diabetes, including 8.5 million Americans who were undiagnosed. 7 Thus, CGM can be performed for less than $0.007 per test. Annual costs for BGM range from $1000 to $3000.6 A continuous glucose monitor (CGM) will cost between $160 and $500 per month but will allow patients to acquire between 2800 and 20,160 interstitial glucose readings over the 10- to 14-day sensor life. 1 If the cost of a single test strip is $1.16, a patient performing BGM twice daily would spend $2.32 per day or $69.60 monthly in addition to incur-ring the initial charge of the actual meter. 4,5 There can also be significant costs associated with obtaining testing supplies, and fingersticks are painful and burdensome to patients, as some require upwards of 4 to 10 per day. 3 The variation in testing frequency is also complicated by the lack of adherence to BGM testing agreed to, which will help delay or prevent diabetes-related complications. However, more frequent testing is associated with more accurate glycemic control. There is a wide variation in the clinical recommendations and personal agreements between patients and their healthcare providers (HCPs) concerning BGM frequency.
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1,2 Traditionally, blood glucose monitoring (BGM) has been the gold standard for persons with diabetes to self-monitor their blood glucose levels. 1 The prevalence of diabetes has reached global pandemic levels, and is a major cause of morbidity, mortality, and significant resource use worldwide. Diabetes is a complicated, chronic illness that requires frequent and consistent care.