Diabetes costs employers billions every year in both direct costs and indirect costs, as the disease impacts productivity and absenteeism, according to new data from Nomi Health.

The direct healthcare provider analyzed the costs associated with diabetes as part of its Trends in Spend Tracker, which uses claims data to identify shifts in healthcare spending. Nomi Health examined about 500,000 employer claims, and estimated that diabetes costs them $245 billion per year.

Of that, about $175 billion in annual spending is direct costs, such as medication and treatment. The remaining $70 billion is related to indirect costs, such as absenteeism, lost productivity and disability, according to the report.

“Diabetes is an urgent and costly epidemic that is only getting worse,” Nomi Health co-founder and CEO Mark Newman said in the release. “As diagnoses skyrocket, so do the associated costs for both employers and patients.”