Economic Toll of Diabetes Begins Early

From the New York Times . . .

Economic Toll of Diabetes Begins Early


Diabetes may be more than a hazard to health. A new study shows that young adults with the disease have lower lifetime earnings and fewer job prospects than their peers.

The new research helps quantify the nonmedical costs of a burdensome disease that afflicts nearly 10 percent of Americans. The study did not distinguish between Type 2 diabetes, which is closely linked to obesity and inactivity and is by far the most common form of the disease, and Type 1, sometimes called juvenile diabetes, which may be linked to immune, genetic and environmental factors. But both types of diabetes are on the rise in young people: About 215,000 Americans younger than 20 have Type 1 or Type 2 disease.

The study, which tracked 15,000 people over a period of 14 years, from high school through their early 30s, found that people with diabetes could expect $160,000 less in earnings over the course of their lifetimes compared with those without the disease. They had lower rates of finishing high school and were less likely to move on to college than young adults who were not diabetic. By age 30, a person with diabetes is 10 percent less likely to have a job, in part because of reduced education.

The findings, published in the journal Health Affairs, “are important because they reflect that diabetics may be having some negative consequences pretty early on in the course of life,” said Dr. Michael Richards, a physician and doctoral candidate in the department of health policy and administration at Yale and an author of the study. They “also beg the question of what the underlying influences that are driving these associations may be.”

One driving force, Dr. Richards suspects, may be the difficulty in balancing school or job demands with the management of a chronic disease. Employers may also be less likely to hire someone with diabetes because they fear they will take more sick days or be less productive or more of an insurance burden than other workers. People with diabetes themselves may also be reluctant to seek out better-paying jobs for fear of losing health benefits, a phenomenon known as job lock.

“Diabetes could also affect the incentives for people in terms of how much schooling they want to acquire, and it could also change incentives for employers who might expect larger medical spending for their diabetic employees,” Dr. Richards said. “Probing further into these potential mechanisms is going to be a goal of future work.”

Earlier studies have shown that chronic disease and other aspects of a person’s health can pose barriers in the job market. The overweight and obese, for example, face job discrimination and often earn less than their thinner counterparts. And researchers have previously shown that diabetes can hamper productivity and hurt employment prospects among older Americans. But Dr. Richards and his colleagues wanted to work backward to see if a similar pattern might occur with younger patients.

They found that high school students with diabetes had a dropout rate 6 percent greater than that of their peers, and were 10 percent less likely than others to find a job when looking for employment. The study controlled and adjusted for the effect of being overweight, a factor in Type 2 diabetes, as well as other family, environmental and demographic factors — and diabetes was still shown to have a direct and independent effect.

The researchers were surprised to find that diabetes also had an intergenerational effect. Young people in the study, regardless of whether they had diabetes, were 6 percent less likely to attend college if they had a parent with the disease. One explanation is that parents with diabetes might have fewer financial resources and less time and energy to devote to their children because of the encumbrance of managing the disease, Dr. Richards said. “It’s a novel and intriguing finding,” he said, “and if it is indeed a real phenomenon, then it suggests that the societal burden of diabetes has perhaps been underestimated.”

Ugh, IMO, any study that does not differentiate between type 1 and type 2 diabetes is incredibly flawed and not reliable. They are two different conditions. If someone develops type 2 diabetes in their late 20s, they are likely already through their college education. However, for those of us who developed type 1 as young children, we had to experience having T1D while in school. I am sure many of us can think of ways this impacted our academic progress, either because of the difficult of managing BGs or the perceptions of those around us. Also, the management intensity of type 1 is so different that it just seems logical that the impact would be very different.

I totally agree.

Also, there is a difference in socioeconomic status between type 1 and type 2, in that the latter is tied to SES whereas type 1 is independent of it. I hope they controlled for these factors, but I still don't see the usefulness of results that lump together these two very different diseases.

For example, type 2 can (usually/often/generally---please don't attack me) be prevented, so there are different recommendations that can be made to remedy the problem of lesser educational attainment, lower earnings, etc., by preventing the disease to begin with.

And, in some countries, type 1s are restricted from certain high-paying jobs, like commercial airline pilot. Type 2s are not, so that possible reduction in average earnings does not apply to them.

As a type 1, I made sure that I did well in school so that I could get a job that paid me well and provided great medical benefits, but I did discount some careers because I knew the job would be too demanding to maintain good control of my BG.

I am actually going through all the articles that appeared in this issue of Health Affairs. They are (not surprisingly) almost uniformly about type 2 diabetes. Nothing specific about type 1 and very few references to it so far.

Not only can type 2 be prevented in many/some cases, but what is needed to control it varies so widely. Some people require "lifestyle" changes, others only require oral medication. As type 1s, we ALL require insulin. There's no getting around that. And we all require intensive BG management which has HUGE impacts on our ability to work, get through school, etc.

This really frustrates me. I am so tired of encountering even health professionals who don't know the difference between type 1 and type 2 diabetes. It really makes me scared for my health sometimes.

I AGREE! Not only health care professionals but the media too. sorry, I'm not a type 2 and don't want to be put in that category. I wish they'd rename either just continues with the ignorance when it comes to autoimmune type 1 diabetes (causes, management, etc..); makes me angry and frustrated too.

Yeah I agree, it fustrates me as well. The other day my mother mentioned to her new sister-in-law I was diabetic. She (my mom's sister in law) promptly goes on to say WELL WHAT DID SHE DO TO GET IT??? I mean yes please tell me I'd love to know...all I was, was just a tall, slender active 11 year old kid, I didnt eat LOTS of junk food...sure I was a kid I liked sodas and chips and sweets...but it wasnt like that was ALL I ate. I've always ate really well, and have tended to eat a pretty balanced diet. NO you wanna KNOW what I did to get it, I was UNFORNTUNATE ENOUGH TO GET THE FREAKING FLU, AND MY BODY TURNED AGAINST ME. But thanks for making me feel like it COULD have been prevented. Guess next time I'll just buy a germ warfare mask and not breath in any virus or bacteria that are floating around out there.

Ugh, that's horrible. I am generally ok at setting people straight who are not in the health care field. It's annoying, but I try to remind myself that not everyone lives in my little "diabetes bubble." However, when this stuff comes from health care professionals, it frightens me beyond belief. These are the people who are supposed to be caring for me!!!

well, i'm sorry to hear that, christy. and, that's just a theory anyway..maybe it was some virus you caught...they don't know...? and, eating anything, nothing, everything has nothing to do with 'catching' or being diagnosed type 1 diabetes anyway.

The costs are big either way I think. As a type 1 that had to go through college dealing with the constant expenses associated with the disease (and not having adequate insurance to cover it all), it was hard. And I know it is difficult for many others also. The Diabetes industry makes a lot of money from patients, and unless we find a cure, they will continue to do so indefinitely.

There is almost no one working on "our side", however. The charity foundations claim to do, and although they have a lot of good people in their circles, the way they spend the money from fundraisers seems to suggest otherwise...

It is a frustrating situation and we need to change things.

The more I think about it, more than I even want to see a cure, I want to see full coverage for all people who are completely dependent on insulin to survive. Some kind of insurance coverage at the national level so no type 1 diabetic is ever in the situation that many of us went through in college, wondering if we would be able to afford insulin and test strips, struggling with insurance, begging for freebies, etc. I think it's apalling that there are type 1s in the U.S. struggling to obtain the basics to manage their condition.

Yes, a cure would be great, but autoimmune diseases are tricky and it's likely not going to happen anytime soon. There's some promising research with stem cells, but this is still years away.

I saw someone somewhere (Jen maybe?) had posted that 40% of T2 take insulin, at which point the treatment would be so similar, other than barriers insurers and doctors place in the way of T2 from getting enough supplies covered to treat it because they are not T1, that the diseases would be the same froman economic standpoint. I don't mind a study like this lumping everyone with any 250 dx code into it. While there are differences, the "bottom line" that with either type there's burdens beyond the PITA of counting carbs, MD visits, tests, etc. I wouldn't disagree with that.

The conclusion should be that we should get a tax deduction for all the crap we have to buy. It's challenging enough to get rx's for the damn test strips and pump supplies and I don't even bother with lancets, alcohol swabs or that sort of thing. Not to mention jelly beans...

Acid ...In Canada , we may qualify for the Disability Tax Credit ...a discussion started Jan 2009 in the Canadian Group ...Disability tax credit for type 1 persons with diabetes,posted by nel on January 2, 2009 at 5:10pm addtional comments since Nov 2011 ; lots of reading ! To include type 2 on MDI , I understand ,
And jelly beans are not a taxable refund , ha, ha

Tu Friend Barb Wagstaff ( Marche ) blogs about this on her page in detail ; Canadian Diabetes Association mentions topic on their web .

A more recent Government sponsored plan is Disability Savings Plan
Posted by BJ on July 27, 2011 at 1:08pm in Canada Diabetes

I hope I copied and pasted enough info here for the Canada crowd ??

Wow! That's awesome! Even if you are not "disabled", if you have to blow $2-3K/ year on pump stuff, I don't think you should be taxed on it. I am pro-tax but that's a bit absurd.

One has to proof with Doc's help when completing the forms !!!! , managing diabetes takes a min of 14 hours weekly ...and some docs do not know , how to complete the forms ...ask me :( ...and then one tries again with one who knows !
Knowing this ..will you move to the Shuswap , aka paradise ??

You trade shoes? I have quite a few shoes that are a bit long in the tooth...

Hi AR: It's more like 25% of T2s use insulin, since LADAs (adult-onset Type 1 diabetes) are lumped in with that oft-quoted "40%". Gotta love the completely irrational.

We'll, there's still quite a few T2 using it. Then there might be the question of how many many might be using it, since the tendency is to avoid it?

i wish people would stop using the term LADA, my Endo doesn't use it, none of my doctors do. there's not even a Dx code for 'LADA'. I'm a type 1 diabetic. The characteristics can and are exactly the same as when a 'child' is diagnosed with type 1; some have rapid onset, present in DKA, others do not, some have a honeymoon, some need a lot, a little insulin, start out with a lot of insulin, titrate down due to honeymoon. there is no difference between a child and an adult being diagnosed with type 1 (other than an often times wrong diagnosis of type 2 by an ignorant health care, non-endo, provider)..some children can have symptoms for years too, just like an adult. there is no difference.

Hi T1Gal: I also don't like the term LADA, and as you point out it is simply Type 1 autoimmune diabetes. My point, worded better, would be "10% of Type 2 diabetics have been misdiagnosed and actually have Type 1 diabetes. However, despite the fact that they have Type 1 diabetes, and this sizeable population is well-known and documented, they are still included in the statistics for incidence/prevalence of Type 2 diabetes, despite not having that disease. This results in the undercounting of the true number of people with Type 1 diabetes, and the overcounting of people with "Type 2" diabetes who use insulin."

I agree re LADA too, I would have to look it up to use it and would be worried I'd offend someone by misconstruing some aspect of it. It seems like a "slow dive" that doctors don't catch, perhaps compounded by insurers trying to control things "you are T2, you are old, you only get 8 test strips/ week..." garbage when what's really needed is more data to nail down what's going on and determine the correct course of treatment as quickly as possible. So the "fun" can start!