Over the past half century, there has been a four- to eight-fold increase in the prevalence of diagnosed cases of diabetes in the U.S. (11) In 2002, the prevalence of diagnosed diabetes among people aged 20 years or older was 8.7 percent and among 60 years or older was 18.3 percent. (12) From 1997 through 2002, the number of new cases of diagnosed diabetes per year increased from 878,000 to 1,291,000 (a 47 percent increase). (13) Projections of diabetes for future years are not encouraging (Figure 1). A 165 percent increase in the number of persons with diabetes in the U.S. is projected through 2050, with a rise from 11 million to 29 million diagnosed persons of all ages. (14) Without preventive action, one in every three children born in the year 2000 will develop diabetes in their lifetime. (15) In addition, minority populations are disproportionately affected by diabetes (Figure 2). On average Blacks, Hispanics, and American Indians and Alaska Natives are more likely (1.6 to 2.3 times as likely) to have diabetes than non-Hispanic Whites. (16) Rates of diabetes-related deaths are higher among Blacks, American Indians, and Hispanics than for Whites, (17) and diabetes is the 5th leading cause of death for Asian and Pacific Islanders. (18) Certain minority groups also have much higher rates of diabetes-related complications, in some cases as much as 50 percent more than the diabetes population. For example, Blacks are more likely to have serious complications from diabetes, such as end-stage renal disease and lower extremity amputations. (19)

Costs of diabetes are high in both human and economic terms. While estimating the national costs for diabetes over time is difficult because of changes in the U.S. population and changes in the cost of health care services, evidence suggests that these costs are high and rising. The American Diabetes Association (ADA) estimated the national cost of diabetes for 2002 to be approximately $132 billion: $92 billion for direct medical expenditures and $40 billion for indirect costs, such as lost work days, restricted activity days, and mortality and permanent disability due to diabetes. (20) Research from the Centers for Disease Control and Prevention (CDC) indicates that people with diabetes miss 8.3 days per year from work, compared to 1.7 days for people without diabetes. (21) In the same ADA study, it is projected that the annual costs of diabetes (in 2002 dollars) could rise to $156 billion by 2010 and to $192 billion in 2020. By 2020, direct medical costs are estimated to increase to $138 billion and indirect costs from lost productivity could increase to $54 billion. (22)