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Over the next 25 years, the rate of diabetes in the U.S. is expected to nearly double, while the cost of treating the disease will skyrocket, according to a recent estimate.

By 2034, there could be as many as 44.1 million Americans with diabetes, an increase from the current 23.7 million. The Medicare population also will see a significant rise in diabetes rates, with the number of cases soaring to 14.6 million, up from 8.2 million today, according to the University of Chicago study of data from the Centers for Disease Control and Prevention. Total diabetes spending is predicted to hit $336 billion in 2034, up from $113 billion. Medicare will see a huge increase in its diabetes outlay. Current Medicare spending on diabetes is roughly $45 billion per year. By 2034, it could be as high as $171 billion, according to the report.

More people are living with diabetes longer. That could explain the dramatic rise in prevalence and cost, researchers say. Related complications later in life, such as kidney dialysis, add significant treatment costs. Additionally, earlier estimates grossly underestimated future diabetes rates. One study from 1991 predicted there would be 11.6 million Americans with diabetes in 2030—less than half the current amount. The report appears in the December issue of Diabetes Care.