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KANSAS CITY, Kan. — A new study finds Americans spent $2.4 trillion on health care in 2013 alone, and diabetes was by far the costliest disease.

J.R. Hanis has had type two diabetes for 38 years. That’s a lot of testing supplies, doctors’ visits and medication including insulin.

“It gets costly and now the stuff is out of sight,” he said.

There’s also the cost of treating complications that Hanis has had including kidney failure which led to a kidney transplant.

Ashlee Orndorff cares for diabetes patients in the University of Kansas Hospital.

“You get kidney disease and heart disease, retinopathy, neuropathy. There’s all sorts of complications that come from diabetes. So we see those readmissions, and every time the patient is readmitted, that’s when costs go up,” said the diabetes nurse educator.

Diabetes is the most expensive disease in America, according to the study in JAMA, which found diabetes’ costs totaled $101 billion in 2013 alone. Heart disease was second at $88 billion followed closely by low back and neck pain at $87 billion.

Researchers say factors making diabetes the costliest disease include an aging population more prone to type two, the common type. In addition, health care providers are more aggressively treating the disease. American lifestyles also play a part.

“You can focus on diet, you can focus on exercise, you can focus on healthy lifestyle,” said Orndorff.

That can lower the chances of getting type two diabetes and also help people with diabetes lower their costs.

Hanis pointed to something else.

“A lot of it is the government regulations. Have you ever watched the paperwork they go through?”

He said that’s making diabetes and other diseases very costly.

Rounding out the top five costliest conditions were hypertension and injuries from falls. Cancer was not even in the top 20 because it was divided into 29 different conditions in the study.