Objective Diabetes is one of the most prevalent and costly chronic diseases in the United States. This study analyzed the risk of developing diabetes and the annual cost of diabetes for a U.S. general population. Methods Data from the Medical Expenditure Panel Survey (MEPS), 2008–2012, was used to analyze (i) probabilities of developing diabetes and (ii) annual total healthcare expenditures for diabetics. The age-gender-race-body mass index (BMI) category specific risks of developing diabetes were estimated by fitting an exponential survival function to age at first diabetes diagnosis. Annual healthcare expenditures were estimated using a generalized linear model with log-link and gamma variance function. Complex sampling designs in the MEPS were adjusted for. All dollar values are presented in 2012 U.S. dollars. Results We observed a >6-fold increase in diabetes risks for class III obese (BMI≥40) individuals, compared to normal weight individuals. Using age 50 as an example, we found a >3-fold increase in annual healthcare expenditures for diabetics ($13,581), compared to non-diabetics ($3,954). Compared to normal weight (18.5≤BMI<25) individuals, class II obese (35≤BMI<40) and class III obese individuals incurred an annual marginal cost of $628 and $756, respectively. The annual healthcare expenditure differentials between diabetics and non-diabetics age 50 were the highest for individuals with class II ($12,907) and class III obesity ($9,703). Conclusions This paper highlights the importance of obesity on diabetes burden. Our results suggested that obesity, in particular, BMI ≥35, is associated with a substantial increase in the risk of developing diabetes and imposes a large economic burden.

Background Multiple myeloma (MM) is one of the most common hematologic malignancies in the United States and is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). Methods A retrospective cohort of patients in the U.S. Veterans Health Administration database diagnosed with MGUS between 1, October, 1999 and 31, December, 2009 and diabetes mellitus prior to their MGUS diagnosis was identified and followed through 6, August, 2013. Patient-level clinical data were reviewed to verify diagnoses and to abstract data on size of baseline M-protein and type of MGUS, i.e., immunoglobulin (Ig) subtype or light-chain, when available. Metformin users were defined as patients that were prescribed metformin for at least 4 years, with no single break between consecutive prescriptions ≥6 months. Kaplan-Meier curves and Cox models were used to analyze the association between metformin use and the progression of MGUS to MM. Findings The analytic cohort consisted of 2,003 MGUS patients with a median follow-up time of 69 months. Within the analytic cohort, 463 metformin users (23·1%) were identified. Among the metformin users, 13 patients progressed to MM, while 74 patients progressed to MM among the non-metformin users. Metformin use was associated with a reduced risk of transformation to MM (Hazard ratio, HR: 0·47; 95% confidence interval, CI: 0·25–0·87). Interpretation For diabetics diagnosed with MGUS, metformin use for 4 years or longer was associated with a reduced risk of transformation of MGUS to MM. Prospective studies are required to determine whether this association is causal and whether these results can be extrapolated to non-diabetics.

Obesity and black race are risk factors for transformation of MGUS to MM. Future clinical trials should examine whether weight loss is a way to prevent the progression to MM in MGUS patients.

Objective This study investigates racial disparity in life expectancies (LEs) and life years lost (LYL) associated with multiple obesity-related chronic conditions (OCCs). Methods Data from the Medical Expenditure Panel Survey, 2008–2012, were used. Four OCCs were studied: diabetes, hypertension, coronary heart disease (CHD), and stroke. LE for each subpopulation was simulated by Markov modelling. LYL associated with a disease for a subpopulation was computed by taking the difference between LEs for members of that subpopulation without disease and LEs for members of that subpopulation who had that disease. Racial disparities were measured in the absolute differences in LEs and LYL between black women/men and white women/men. Results Blacks had higher risks of developing diabetes, hypertension, and stroke. Disparity in LE between whites and blacks was largest in men age 40–49 with at least stroke: blacks lived 3.12 years shorter than whites. Disparity in LYL between whites and blacks was largest in women age 70–79 with at least CHD: blacks had 1.98 years greater LYL than whites. Conclusions Racial disparity exists in incident disease and mortality risks, LEs, and LYL associated with multiple OCCs. Efforts targeting subpopulations with large disparities are required to reduce disparities in the burden of multiple OCCs.

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