Diabetes Health Gains Outpace Economic Progress, Study Finds

While medical breakthroughs have improved the health of people with diabetes, a new study finds that economic outcomes, such as employment rates and disability income reliance, have remained largely stagnant.¹ The findings highlight a growing disconnect between health and financial well-being in Americans aged 40 to 64 years living with diabetes.

Despite advances in diabetes care, new research reveals persistent economic disadvantages for middle-aged adults living with the condition. | Image credit: Pixel-Shot - stock.adobe.com

This cross-sectional study was published in JAMA Health Forum.

The lack of economic convergence is concerning given the large increase in diabetes prevalence, which implies an increasing total labor market burden,” wrote the researchers of the study. “In addition to reducing productivity, this may have increased strain on government budgets if people with diabetes are more likely to use disability insurance programs, as we found.”

To assess whether the relationship between diagnosed diabetes and labor market outcomes has changed over time, researchers conducted a cross-sectional study using data from the National Health Interview Survey spanning 1998 to 2018. The study focused on a nationally representative sample of US adults aged 40 to 64 years. Diagnosed diabetes was based on self-reported confirmation of a medical diagnosis. The researchers estimated average marginal effects—the regression-adjusted differences in outcome probabilities between individuals with and without diabetes—across pooled 3-year intervals. The models controlled for key demographic, educational, and comorbid health factors.

Primary outcomes included labor force participation and receipt of Supplemental Security Income or Social Security Disability Insurance, while secondary outcomes assessed broader health-related limitations and health care utilization.

The study analyzed data from 249,712 individuals, including 25,177 with diagnosed diabetes. Over time, the proportion of older adults aged 55 and up increased in both groups, but more so among those with diabetes. From 1998 to 2018, the negative association between diabetes and labor force participation remained stable, with an average marginal effect of -10.9 percentage points in 1998 to 2000 and -11.0 percentage points in 2016 to 2018. Similarly, individuals with diabetes consistently had a higher likelihood of receiving Supplemental Security Income or Social Security Disability Insurance, increasing slightly from 4.4 to 4.9 percentage points over the same period. In contrast, diabetes-related health outcomes improved significantly, suggesting better clinical management.

These findings align with a similar study published in JAMA Network Open, which found that adults with type 2 diabetes who had stable housing experienced modest but meaningful improvements in key health indicators such as hemoglobin A_1c (HbA_1c), blood pressure, and cholesterol levels compared with those facing housing insecurity.²

However, the researchers acknowledged the study had several limitations.¹ First, it relied on self-reported survey data, which may have been affected by misreporting or recall bias. Additionally, diabetes status was based solely on self-reported diagnosis without objective clinical measures like HbA_1c, potentially limiting the ability to separate changes in diagnosis patterns from actual disease incidence. The surveys also did not differentiate between type 1 and type 2 diabetes, which could have distinct trends in health and economic outcomes. Finally, although the analysis controlled for observed differences between groups, unmeasured factors influencing health or economic trends over time may still have been present.

Despite these limitations, the researchers believe the study showed that although individuals with diabetes showed significant health improvements over time, their economic outcomes remained largely unchanged.

“We posit that changing patient selection plays a role in producing these paradoxical trends,” wrote the researchers. “The social and economic contexts in which many people with diabetes live, in addition to the direct health impacts of the disease, are important to address to develop effective strategies that will reduce the labor market penalties associated with diabetes.”

References

1. Chapel JM, Goldman DP, Kahn ME, et al. Long-term health improvements and economic performance among individuals with diabetes. JAMA Health Forum. 2025 May 2;6(5):e250756. doi:10.1001/jamahealthforum.2025.0756

2. Steinzor P. Housing instability linked to worse type 2 diabetes outcomes. AJMC^®. April 14, 2025. Accessed May 16, 2025. https://www.ajmc.com/view/housing-instability-linked-to-worse-type-2-diabetes-outcomes