Healthy People 2010 Focus Area 5 Diabetes Progress Review December 18, 2002

Diabetes Model Related Deaths Per Year: 200,000 + Reduced Life Expectancy: 5-15 years Medicare: 25% of Costs Estimated Annual Costs: ~ $100 billion (direct and indirect) Societal Costs Acute Complications Amputations Birth Defects Blindness/Eye Disease Dental Disease Flu & Pneumonia-Related Deaths Heart Disease High Blood Pressure Kidney Disease Pregnancy Complications Nervous System Damage Stroke Increase risk for: Self-management of Diabetes Provider Services General Population Pre-diabetes (16 million persons) Diagnosed Diabetes Undiagnosed Diabetes Prevention of Diabetes-Related Complications Prevention of Diabetes Physical Activity Nutrition Healthy Weight Access

American Indian/ Alaska Native White, not Hispanic Black, not Hispanic Asian/Pacific Islander 2010 Target Age-adjusted rate per 1,000 standard population Total Persons with diabetes in the U.S.: 17 million (11.1 million diagnosed million undiagnosed) I 95% confidence interval Diagnosed Diabetes Prevalence, 2000 Source: National Health Interview Survey (NHIS), CDC, NCHS.

0-44 Years Total Years Years 75+ Years Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in Source: National Health Interview Survey (NHIS), CDC, NCHS Prevalence of Diagnosed Diabetes by Age: United States,

0-44 years Total years years 75+ years 5-3. Prevalence of Diagnosed Diabetes by Age: United States, Percent change ( )( ) Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in Source: National Health Interview Survey (NHIS), CDC, NCHS.

5-3. Prevalence of Diagnosed Diabetes by Race/Ethnicity and Gender Black females Black males White females White males Age-adjusted rate per 1,000 standard population Hispanic males Hispanic females Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in Source: National Health Interview Survey (NHIS), CDC, NCHS.

5-3. Prevalence of Diagnosed Diabetes by Race/Ethnicity and Gender Black females Black males White females White males Hispanic males Black female Hispanic male +4 Black male +50 Hispanic female +2 White male White female Percent Change Age-adjusted rate per 1,000 standard population Hispanic females Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in Source: National Health Interview Survey (NHIS), CDC, NCHS.

5-3. Prevalence of Diagnosed Diabetes, Adults 18 years and over, by State, United States Note: 1994: 3-Year Average; 2000: 2-Year Average. Source: Behavioral Risk Factor Surveillance Survey (BRFSS), CDC, NCCDPHP Age-adjusted percent <4% 4-4.9%5-5.9%6+%

*Note: Diagnosed incidence derived from algorithm using age at interview and age at diagnosis. Source: National Health Interview Survey (NHIS), CDC, NCHS. American Indian/ Alaska Native White, not Hispanic Black, not Hispanic Asian/Pacific Islander 2010 Target Age-adjusted rate per 1,000 standard population Total 5-2. Diagnosed Diabetes Incidence*: Adults Age 18-84, by Race/Ethnicity, ** **Unreliable estimate, relative standard error >30%. I 95% confidence interval.

Source: National Vital Statistics System-Mortality, (NVSS-M), CDC, NCHS. American Indian/ Alaska Native White, not Hispanic Black, not Hispanic Asian/ Pacific Islander 2010 Target 5-5. Diabetes-Related Death Rates*: 2000 Age-adjusted death rate per 100,000 standard population Total *Any mention of diabetes on death certificate as underlying or contributing cause.

Source: National Vital Statistics System (NVSS-M), CDC, NCHS. White, not Hispanic Black, not Hispanic 2010 Target 5-7. Cardiovascular Disease Death Rates Among Persons with Diabetes, 2000 Age-adjusted death rate per 100,000 standard population TotalFemalesMales Note: Data for American Indian/Alaska Native and Asian/Pacific Islander are not shown due to small cell sizes. All Cause Deaths in Persons with Diabetes 820 per 100,000

. Projected Increase in Total Heart Disease Deaths Related to Increased Diabetes Prevalence Heart Disease Deaths (thousands) 21% 29% Proportion of heart disease deaths due to diabetes Source: Unpublished estimates from the National Heart, Lung, and Blood Institute, October 18, 2002.

Projected Increase in Total Heart Disease Deaths, U.S. Population Heart Disease Deaths (thousands) Diabetes Mellitus Prevalence Increases Diabetes Mellitus Prevalence Unchanged

2010 Target Lower Extremity Amputations Among Persons with Diabetes, Age-adjusted rate per 1,000 standard population TotalBlackWhiteFemaleMale< Age (not adjusted) I 95% confidence interval. Note: Data for American Indians/Alaska Natives, Asian/Pacific Islanders and Hispanics are not shown due to small cell sizes. Source: National Hospital Discharge Survey (NHDS) and National Health Interview Survey (NHIS), CDC, NCHS.

Sources: CDC: Behavioral Risk Factor Surveillance Survey (BRFSS), NCCDPHP; National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), NCHS. * Target-to-be-determined. **Exceeds total population target (50%). Diabetes-Related Complications: Provider Services For Adults with Diabetes Annual Influenza vaccination Pneumococcal Vaccination (ever) Age Most recent level2010 Target * Age-adjusted percent Age 65+ Direction desired Age 18-64Age 65+ Annual exam 2 x year % 60% 55% 65% 75% 90% 60% 90% 51% 36% 68% 23% 60% ** 60%

Source: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. American Indian/ Alaska Native White, not Hispanic Black, not Hispanic Asian/Pacific Islander A1C Tests: Persons with Diabetes, 2001* Age-adjusted percent receiving two or more tests in the past year** **Target-to-be-determined. Total *41 reporting States and D.C. I 95% confidence interval.

5-13. Annual Dilated Eye Examinations: Persons with Diabetes, by Race/Ethnicity White, not Hispanic Black, not Hispanic 2010 Target Total Hispanic Age-adjusted percent Note: Data for American Indians/Alaska Natives are for IHS Service Areas. Asian/Pacific Islander data are not shown due to small cell sizes. I 95% confidence interval. American Indian/ Alaska Native Sources: National Health Interview Survey (NHIS), CDC, NCHS, and Indian Health Service.

Source: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. American Indian/ Alaska Native White, not Hispanic Black, not Hispanic Asian/Pacific Islander 2010 Target Age-adjusted percent Annual Foot Examinations: Persons with Diabetes, 2001* Total *41 reporting States and D.C. I 95% confidence interval.

Provider Services Utilization: Persons with Diabetes by Education Level Age-adjusted percent A1C Test 2 x year Eye Dental Diabetes Education (1999) Foot Annual Exam (2001) Less than high schoolAt least some college (1999)(2000)(2001) Sources: CDC: Behavioral Risk Factor Surveillance Survey (BRFSS), NCCDPHP; National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), NCHS. I 95% confidence interval

Sources: CDC: Behavioral Risk Factor Surveillance System (BRFSS), NCCDPHP; National Health and Nutrition Examination Survey (NHANES), and National Health Interview Survey (NHIS), NCHS. Diabetes-Related Complications: Self-Management of Diabetes: Adults with Diabetes Self monitoring blood glucose 2010 TargetMost recent levelDirection desired 60% 30% 60% 50% 57% 20% 12% 21% Age-adjusted percent

Source: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. American Indian/ Alaska Native White, not Hispanic Black, not Hispanic Asian/Pacific Islander 2010 Target Age-adjusted percent Self-Blood Glucose Monitoring: Persons with Diabetes, 2001* Total *41 reporting States and D.C. I 95% confidence interval.

Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. Black, not Hispanic MalesFemales Mexican American White, not Hispanic 2010 Target Aspirin Therapy*: Persons with Diabetes, Age 40 years and Over, Age-adjusted percent Total *Took aspirin at least 15 times in past month. I 95% confidence interval.

Sources: National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. Moderate physical activity Age-adjusted percent High blood pressure Obesity Persons with diabetesPersons without diabetes Healthy weight Selected Risk Factors I 95% confidence interval

Moderate physical activity Age-adjusted percent High blood pressure Obesity Persons with diabetesPersons without diabetes Healthy weight Selected Risk Factors I 95% confidence interval Sources: National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. *Body Mass Index > Obesity*: Adults Age 20 and Over, by Race/Ethnicity White, not Hispanic Black, not Hispanic 2010 Target Total Mexican American Age-adjusted percent I 95% confidence interval.

Age-adjusted percent Note: Obesity is Body Mass Index > 30. Obesity data for are for ages Sources: National Health and Nutrition Examination Survey, CDC, NCHS. ( ) ( ) ( ) Obesity Prevalence: Adults Age 20 and Over

Prevalence of Diagnosed Diabetes : Note: Diagnosed diabetes data are 3-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in Sources: National Health Interview Survey, CDC, NCHS. Age-adjusted percent

Developmental Objectives Decrease the proportion of pregnant women with gestational diabetes (future source, National Vital Statistics System-Natality) Reduce frequency of foots ulcers in persons with diabetes (future source, National Health and Nutrition Examination Survey) Increase the proportion of persons with diabetes who obtain an annual urinary albumin measurement (proposed source, Behavioral Risk Factor Surveillance System)

Projected Diagnosed Diabetes in the U.S. Projected number of people with diagnosed diabetes (millions) Population growth assumption* High Middle Low *All population projections assume increasing diabetes prevalence rates. Reported Projected 1975 Sources: U.S. Census Bureau, National Health Interview Survey (NHIS), CDC, NCHS. Boyle et al. Diabetes Care, Vol. 24, No.11, November 2001.

2010 Target Progress review data and slides can be found on the web at:

Data Notes Objective numbers in the “Provider Services For Adults with Diabetes” slide are as follows: A1C test (5-12), foot (5-14), dental (5-15), eye (5-13), education (5-1), high blood pressure control (12-10), and influenza /pneumococcal vaccination (14-29). Objective numbers in the “Self-management of Diabetes” slide are as follows: self-monitoring blood glucose (5-17), aspirin use (5-16), healthy weight (19-1), and moderate physical activity (22-2). Objective numbers in the “Selected Risk Factors” slide are listed above except for high blood pressure (12-9). Data are age adjusted to the 2000 standard population. The American Indian/Alaska Native and Asian Pacific Islander categories include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race.