 a. Historical background The Center for Disease Control and Prevention CDC estimates that there are currently 29 million people with diabetes and 86 million people with pre-diabetes in the U.S. One in 10 Americans has diabetes now, and, if current trends continue, 1 in 3 Americans will have diabetes by 2050. This chronic disease significantly impacts both quality of life and rapidly rising national healthcare costs. The estimated cost of diabetes in the U.S. in 2014 was 265 billion with 176 billion in direct medical costs and 89 billion is indirect medical costs disability, work loss, premature mortality. Medical expenses for people with diabetes are 2.3 times higher than for people without diabetes. 