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Recall of metformin extended release

In May 2020, the Food and Drug Administration (FDA) recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. This is because an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets. If you currently take this drug, call your healthcare provider. They will advise whether you should continue to take your medication or if you need a new prescription.

In 2010, a study estimated that between 25 and 33 percent of American adults could have diabetes by 2050, either diagnosed or undiagnosed. Approximately 90 to 95 percent of the more than 30 million Americans with diabetes have type 2 diabetes.

With these numbers, it’s no surprise that the cost of this condition, specifically type 2 diabetes, continues to be of concern.

Yet understanding the direct and indirect expenses of living with type 2 diabetes for those not within the community isn’t always clear. In short: It’s extensive.

To shine a spotlight on just how much living with type 2 diabetes in America costs, we looked at the figures from both an overall and individual perspective. Here’s what we found.

When we look at the overall financial cost of living with diabetes, it’s helpful to break it down both annually and monthly. This gives us a bird’s-eye view of how this expensive health condition impacts the United States healthcare system, especially those living with type 2 diabetes.

Here are the facts: The cost of all types of diagnosed diabetes in the United States is $327 billion in 2017, according to the American Diabetes Association. This includes both direct ($237 billion) and indirect ($90 billion) costs.

The economic costs of diabetes increased by 26 percent in the last five years. And people with all types of diabetes often spend $16,750 per year on medical expenses. More than half of that amount ($9,600) is directly related to diabetes.

Direct costs

The direct costs of living with diabetes includes:

  • medical supplies
  • doctor’s visits
  • hospital care
  • prescription medications

Of the $237 billion spent on direct costs in 2017, hospital inpatient care and prescription medications to treat diabetes make up the bulk of the total.

Together, these two direct costs account for 60 percent of the total amount. The remaining costs include:

  • antidiabetic agents
  • diabetes supplies
  • physician’s office visits

Indirect costs

The indirect costs of diabetes have the ability to seriously affect livelihood. A 2016 study found that those with type 2 diabetes had higher levels of depressive and anxiety symptoms.

Likewise, while loss of overall work, job opportunities missed, and a reduction in the number of hours a person is able to work can take a toll on mental well-being, it also has monetary consequences.

In 2017, the inability to work because of diabetes-related disability cost $37.5 billion, while for those with jobs, absenteeism accounted for $3.3 billion. Moreover, the reduction in productivity at work for those employed costs a staggering $26.9 billion.


If there’s one thing that remains constant about diabetes, it’s that it doesn’t discriminate.

Anyone, regardless of race, gender, or socioeconomic class can have diabetes. However, there are certain groups of people who are more susceptible to diabetes. Because of this, it’s important to look at the difference in costs for various groups of people.

The first distinction to consider is sex. Men are at slightly higher risk for type 2 diabetes than women. Likewise, healthcare costs are somewhat higher for men than they are for women. In 2017, men spent $10,060 and women spent $9,110 on medical expenditures related to diabetes.

Breaking it down even further by race, non-Hispanic black Americans face the highest per person expenses related to diabetes, which totaled $10,473 in 2017. Non-Hispanic white Americans face the second highest costs related to diabetes, totaling more than $9,960 that same year.

Meanwhile, Hispanic Americans face $8,051 in per person healthcare costs related to diabetes, and in general, are 66 percent more likely to get a diabetes diagnosis than white Americans. Moreover, non-Hispanic races face expenses of $7,892 per person.

The annual expenditures only paint one picture: overall financial costs. What those statistics and amounts don’t take into consideration, however, are the day-to-day and monthly costs that add up, both monetarily and emotionally.

For 51-year-old Stephen Pao, the cost of diabetes includes those incurred both for the traditional medical costs from when he first got a diagnosis, and the costs associated with the alternative therapies he now uses to help reverse the disease.

Receiving a type 2 diagnosis at age 36, Pao, who lives in Portland, Oregon, followed the traditional treatment path which included taking four prescription medications.

Pao says that prior to seeking alternative treatments, his insurance company would share the medical costs as part of a health plan.

For the more traditional course of action, Pao says his monthly costs — based on copays from a high-deductible health savings account — were about $200 per month. This included:

  • Prescriptions. Metformin, glyburide, a statin, and a high blood pressure medicine cost $100
    per month.
  • Doctor’s visits and lab work. Dividing up the total cost into equal monthly
    payments, this cost around $40 per month. These were usually done quarterly.
  • Miscellaneous events. For the big events, whether it was getting sick — urgent care
    visits for pneumonia, for example — or going back to refresher diabetes
    training courses, the estimated cost for this is $20 per month.
  • Supplies. Blood testing strips, batteries, and other related items cost another $40 per month.

For Joe Martinez, his type 2 diagnosis left him struggling with more than stress over direct costs. For the founder and president of Healthy Meals Supreme, it was coming to terms with the notion that he’d live with this chronic disease for the rest of his life.

“I had to cope with the mental and emotional realization that I had a chronic disease and there was no cure for it. [All I could do is] manage it,” he reveals.

Martinez was determined to examine what he needed to do in order to live as much of a “normal” life as possible. But this research left him feeling even more overwhelmed.

“I started to Google information and was quickly overwhelmed with the sheer volume of information,” he explains.

Currently, the registered pharmacist who lives in Plainsboro, New Jersey, breaks his direct costs down by 90-day payments: roughly $280 per month, with a $4,000 deductible at the beginning of the year.

  • Prescription
    About $65 per

    • Cholesterol
      $50 copay for 90-day supply, about $16 per month
    • High
      blood pressure medication.
      $50 copay per 90 days, about $16 per month
    • Insulin. Seven vials for 90-day supply at $100
      copay, about $33 per month
  • Glucose
    About $5 per bottle at one to two bottles per month
  • Vitamins
    and over-the-counter medications.
    Total cost about $60 per 90 days, about
    $20 per month
  • Devices.
    About $118 per month

    • Insulin delivery
      $171 coinsurance amount for 90-day supply, about $57 per month
    • Continuous
      glucose monitor (CGM).
      This is worn on skin for 24/7 glucose readings; $125
      coinsurance for 90 days, about $41 per month
    • CGM
      $121 coinsurance for 6-month supply, about $20 per month
  • Supplies.
    About $71 per month

    • Blood
      glucose strips.
      $100 copay for 90-day supply, about $33 per month
    • Glucose
      $25 copay for 90-day supply, about $8 per month
    • Miscellaneous
      $30 per month

Planning and budgeting for the costs of living with type 2 diabetes can feel overwhelming, especially after a new diagnosis. And whether you’re new to the world of diabetes or you’re looking for ideas to tighten up your budget, asking people who live it daily is an excellent way to learn how to start this process.

Budgeting tips

Section 125

The most important thing to do at the beginning of a diabetes diagnosis is to take advantage of an employer’s Section 125 plan or Flexible Spending Arrangement if that’s an option, explains Pao.

The concept is that you can take a pre-tax amount of $2,650 spread out over your paychecks. This money can be used to pay out-of-pocket expenses. The downside, he adds, is that this money is “use it or lose it,” but someone with diabetes generally won’t have a problem using it.

Choose your food wisely

Making good food choices as part of an overall budgeting strategy is important, stresses Martinez. Though fast food might seem like an easier choice in the moment, the long-term consequences far outweigh the convenience.

Not making healthy food choices can result in severe long-term outcomes such as nerve damage, blindness, and kidney damage, which can also cost you financially.

Think twice about self-employment

To those considering self-employment, Pao says to consider insurance costs. He’s currently self-employed and buys his insurance through a marketplace. “With no corporate contribution into plans and the plans available to individuals, premiums are expensive and deductibles are high,” he explains.

That’s why he says people with diabetes should think carefully about self-employment and look at healthcare costs as a part of a decision to leave corporate life.

cost saving ideas

• Choose generic over brand-name prescriptions which may cut costs.
• Talk to your doctor about low-cost insulins. Make sure your insulin is
on formulary — a list of medicines covered by the plan — with your insurance

Funding and resources

Prescription assistance programs

Ask your pharmacist or pharmaceutical companies about their prescription assistance programs. This can help you get free or low-cost prescriptions, especially if you don’t have health insurance or prescription drug coverage.

There are also online resources that help connect patients with programs that offset the cost of medications, including Partnership for Prescription Assistance and RxAssist.


For people ages 65 or older living with type 2 diabetes, enrolling in Medicare can help offset costs.

Part B generally covers a portion of the costs of up to two diabetes screenings each year, self-management training, home blood sugar testing equipment, insulin pumps, foot exams, and glaucoma tests.

Part D, meanwhile, provides certain kinds of insulin as well as the medical supplies needed to administer it.

Federally Qualified Health Center

Visit a Federally Qualified Health Center. These can be helpful for people covered under disability and low-income level programs.

If you’re wondering what to buy at the grocery store, the American Diabetes Association has a comprehensive shopping list you can print and take with you on your next shopping trip.

Pao and Martinez outline some of their own must-haves that include food items, dietary supplements, and tech products:

Sara Lindberg, BS, MEd, is a freelance health and fitness writer. She holds a bachelor’s degree in exercise science and a master’s degree in counseling. She’s spent her life educating people on the importance of health, wellness, mindset, and mental health. She specializes in the mind-body connection, with a focus on how our mental and emotional well-being impact our physical fitness and health.