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Diabetes Management in the United States

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Abstract

In 2020, diabetes affected 37.3 million Americans, of whom over 20% remained unaware of their diagnosis. Diabetes is one of the leading contributors of rising healthcare costs in the United States and disproportionately affects Americans from minority race/ethnicities and lower socioeconomic backgrounds, leading to disparities in diabetes care across the United States. Despite advances in care and established evidence-based recommendations for screening and management to prevent micro- and macrovascular complications of diabetes, control of diabetes-related risk factors (including glycemic, blood pressure, and lipid indices) has plateaued and more recently declined. With this, rates of emergency department use and complications have started to increase again since 2015, despite marked declines from 1990 to 2010. Promising advances in therapeutics, including SGLT2 inhibitors, GLP-1 receptor agonists, and DPP4 inhibitors, have the potential to improve glycemic control and cardio-metabolic outcomes for patients with diabetes, yet cost remains a barrier to access for most Americans. This chapter reviews US guidelines for diabetes detection, management, and maintenance and provides a review of disparities in diabetes care and outcomes. Further, this chapter catalogues examples of approaches and implementation strategies used in the United States to improve diabetes care and related disparities at the health system, payer, and policy level.

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Authors and Affiliations

  1. Department of Family and Preventive Medicine, Emory School of Medicine, Dunwoody, GA, USA

    Megha K. Shah

  2. Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA

    Farah Naz Khan

  3. Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA

    Mohammed K. Ali

  4. Department of Family and Preventive Medicine, Emory School of Medicine, Atlanta, GA, USA

    Mohammed K. Ali

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  1. Megha K. Shah
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  2. Farah Naz Khan
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  3. Mohammed K. Ali
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Correspondence to Mohammed K. Ali .

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  1. Mexico City, Mexico

    Joel Rodriguez-Saldana

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Shah, M.K., Khan, F.N., Ali, M.K. (2023). Diabetes Management in the United States. In: Rodriguez-Saldana, J. (eds) The Diabetes Textbook. Springer, Cham. https://doi.org/10.1007/978-3-031-25519-9_19

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