According to a massive followup of 242,383 patients by the Centers for Disease Control and the National Institutes of Health, incremental improvements in the quality of diabetes care over the period from 1997 to 2006 have reduced the number of deaths caused by diabetes from 10.8 to 6.1 per 1,000 person-years.
It may not sound like much, but an extra 1% chance of death each year adds up, in the case of diabetics from 1996, to a lifespan shortened by an average of ten years. And with 26 million diabetics in the United States alone, that 4.7 per 1,000 reduction translates to a whopping 122,200 lives saved. It's like stopping a 9/11 every nine days.
There has been no great breakthrough in diabetes care. The autoimmune Type I and the obesity-related Type II forms both remain serious and often incurable. Yet somehow, the incremental improvements in care over the decade have added up. Because the study was simply statistical, it is not immediately known which factors were most important in the decrease. Likely candidates include improved control of blood pressure and cholesterol with medication. Other management of risk factors such as reduced rates of cigarette smoking and increased exercise seem to have contributed. The authors made a fairly convincing effort to rule out the possibility that the improvement was simply from diagnosis at earlier stages of the disease, by excluding people diagnosed within two years, which did not alter the result.
As we head toward a contentious election, and perhaps an even more contentious debate about the future of federal spending, the agencies responsible for this study, and for much of the routine basic research that contributed to many small improvements in diabetes treatment, are facing budget cuts of up to 12%, or at best, flat funding unadjusted for inflation. The proposed NIH budget is $31 billion, and the proposed CDC budget is $11 billion. We should consider carefully whether saving at most $5 billion in this way is truly in our best interests.