When treated properly, the harmful impacts of diabetes can be minimized such that patients can often enjoy a long, healthy, and mostly “normal” life. However, concluding that this condition is therefore benign would be a mistake; left untreated, diabetes can impose extremely severe consequences that range from debilitation to death.
Unfortunately, the bad news doesn’t end there. Being such a common condition, diabetes extracts a substantial cost from American society each year. And, with trends in the prevalence of diabetes looking grim, that cost is only set to expand.
This article explores the costs of failing to take diabetes seriously at an individual and societal level, as well as some tips to ensure diabetes doesn’t go untreated.
Effects on Individuals
Given that diabetes is readily treatable in many cases, one might question why a discussion of untreated diabetes is worth having in the first place. However, there exist several reasons why a person might, and many people do, fail to receive adequate treatment of their diabetes. First, diabetes can be deceptively difficult to notice in many cases, particularly early on, and second, diabetes medications are notoriously expensive. Many people either don’t know they have diabetes, or know they have it, but do not have the means or the healthcare coverage to access the care they require.
In fact, 8.5 million Americans are estimated to have undiagnosed diabetes of some form, while another 1.3 million Americans reported rationing their insulin supplies due to insufficient financial means in 2021, giving a total of close to 10 million Americans receiving insufficient treatment for their diabetes. Given these figures, it’s worth discussing what impacts these individuals may be suffering as a result.
Given enough time, many cases of untreated diabetes are likely to lead to a number of very serious health complications. Because diabetes is a systemic condition, meaning that it affects the entire body, complications can manifest in nearly any of the body’s organs and systems. However, certain conditions are noted as being particularly common and problematic amongst those with chronic untreated diabetes.
Hyperglycemia is a hallmark of untreated diabetes. This presence of excessive amounts of sugar is destructive and accounts for many complications. For example, high blood sugar wages a constant assault against the nervous system, causing lasting damage to nerves throughout the body. This can manifest as neuropathy, a condition characterized by numbness or tingling in parts of the body – often in the legs. It can also damage more critical nervous structures, like those in parts of the brain, contributing to accelerated cognitive decline. This may be why type 2 diabetes has been linked to a higher prevalence of developing Alzheimer’s disease.
Our circulatory systems are also common victims of untreated diabetes. A wide range of cardiovascular conditions, including various forms of heart disease, stroke, and high blood pressure, can all result from the corrosive impact of high blood sugar on the veins, arteries, and capillaries in our bodies.
The structures which depend on our circulatory system for their supply of oxygen and nutrients can also suffer from this degradation. Vision problems including blindness can result from the deterioration of vital blood vessels in the retina, the structure responsible for perceiving light in our eyes. The body’s extremities, including the arms, legs, hands, and feet, also commonly fall victim to an impaired circulatory system. Infections in these areas are not uncommon and can become necrotic and require amputation in severe cases. Even vital organs like the kidneys suffer from damage to important blood vessels that impair their ability to remove waste products from the blood. Chronic kidney disease often results and can lead to kidney failure in some cases.
In light of the list of complications above, it is unsurprising that untreated diabetes can significantly reduce a person’s lifespan as compared to a diabetic counterpart receiving proper care. Research has shown that this discrepancy could be as wide as 10 years for type 2 diabetics, highlighting the benefits of treatment.
For type 1 diabetics, the picture may be a little more stark. This is because an acute condition known as diabetic ketoacidosis (DKA), which mostly impacts type 1 diabetics, can cause death in a matter of hours in untreated patients, as opposed to over several decades. When a type 1 diabetic’s body is totally unable to import sugar into its cells for lack of insulin, the body resorts to breaking down fats for energy. This process creates by-products called ketones. When enough of these ketone molecules build up in the bloodstream in a short enough timespan, the consequences can be fatal. Fortunately, the condition is largely preventable with proper treatment and insulin administration.
Starting treatment early is undoubtedly better than starting it late, but as the classic saying goes, “it’s better late than never”. For patients who have been unable to access treatment for their diabetes and have suffered complications in the interim, there may be cause for optimism. Some evidence suggests that many chronic diabetes complications may be reversible to an extent with the introduction of proper treatment. Obviously, each complication – and patient – must be considered in its own context; the human body is extraordinarily complex and generalisations should therefore be made with caution. However, some studies have shown remarkable promise for the body’s ability to recover when conditions become favorable.
As examples, two studies investigated whether diabetes-induced kidney damage could be reversed through amelioration of the underlying condition. In one study, this was done by transplanting the kidney into the body of a non-diabetic individual, while in the other, the researchers assessed kidney function following a pancreas transplant to restore some insulin producing capacity. Both studies found some improvement of function over many years. Less drastic was a study that showed that simply placing diabetic mice on a ketogenic diet and thus improving their glycemic control was sufficient to elicit positive changes in kidney function. From these results, one might conclude that the kidneys, and perhaps other organs, may have some potential for healing once treatment is begun.
Importance of early treatment
An ounce of prevention is often worth a pound of cure, and that certainly appears true with diabetes treatment. It may very well be that some complications of untreated diabetes may be reversible to an extent, but patients would do far better to avoid those complications in the first place. Detecting diabetes early and implementing an appropriate treatment regime before the disease can run rampant are thus the primary means of improving long term health outcomes with diabetes.
Diabetes can be difficult to detect to the untrained layperson, especially early in its development (in the case of type 2 diabetes). Fortunately, telltale signs and symptoms can indicate an underlying condition. If you notice any of the following symptoms, consider speaking to a doctor about being screened for diabetes. Please note that this list is not exhaustive, as some patients may be asymptomatic, or may experience an atypical or unique presentation of the condition.
Signs and symptoms may include:
- An increased need to urinate.
- An excessive level of thirst.
- Blurred or worsening vision.
- Uncharacteristic fatigue.
- Frequent headaches, dizziness, or confusion.
- Unexplained weight loss or weight gain.
Cost to Society
Untreated diabetes is not only harmful at the individual level. In aggregate, it also represents an increasingly large economic burden on American society. And, the problem appears to be growing, thanks to the growing proportion of the population diagnosed with type 2 diabetes each year. To illustrate, consider that the economic burden of diabetes in America grew by 41% between 2007 and 2012, and the number of Americans with diabetes is expected to grow from the current 10% to roughly 33% by the year 2050. The implications of this trend are almost unfathomable.
Direct medical costs
As a category, diabetes-related healthcare costs pose a gargantuan financial cost to the American healthcare system. In 2017, for instance, estimates of the total price tag for diabetes-related healthcare in the US were placed at $403.9B, earning diabetes a spot amongst the most expensive conditions nationwide. Of that cost, only 81% was estimated to result from diagnosed cases of diabetes, with undiagnosed diabetes, prediabetes, and gestational diabetes together responsible for the remainder. Doing the math, that means close to $77B of healthcare costs could be attributed to undiagnosed diabetes and prediabetes in 2017.
In light of this data, the ADA has previously recommended regular screening for type 2 diabetes in adults over the age of 45. The cost of such screening would be vastly outweighed by the savings associated with reducing the number of necessary and costly treatments for preventable complications. Unfortunately, progress on this front has been slow.
Medical costs are not the only expense attributable to diabetes. Another significant part of the equation is the loss in productivity represented by the impacts of untreated diabetes on the workforce. Working people with untreated diabetes are likely to be absent more often, be less productive while working, and spend less time in the workforce due to premature mortality, than their counterparts in treatment. While it may seem morbid to assign a monetary value to human illness and death in this way, studies on this exact value have been performed and have estimated that the amount is not insignificant. In 2007, it was estimated that $69B had been lost in lost productivity due to diabetes. While it is difficult to parse out how much that value would change with fewer untreated cases, even a small fraction still represents many billions of dollars, thus making it noteworthy.
Diabetes is one of the best studied illnesses in the world. Volumes of data have been produced on this illness, which has played a major role in allowing substantial improvements to be made in the treatments that are available. Such data has also allowed us to gain a much clearer picture of how accessible that treatment is, and what the effects of failing to access it would be.
As this article has illustrated, that picture is not pretty. Though it can be managed well, diabetes is a serious condition that, without treatment, is almost certain to cause severe health complications in the long run, and potentially shorten a person’s life. En masse, these effects wreak devastating expenses on the American healthcare system, drawing resources away from other causes. Improving screening and treatment for diabetes, both at the individual and societal levels, should therefore be of primary importance.