1. Diabetes: Public Health Implications Dr. Bruce Goodrow East Tennessee State University

2. Burden of Chronic Disease: More than 90 million persons in the U.S. live with chronic illness More than 90 million persons in the U.S. live with chronic illness

3. Public Health Implications More than 75% of the nation’s 1.4 trillion health care costs can be attributed to chronic illness. More than 75% of the nation’s 1.4 trillion health care costs can be attributed to chronic illness.

4. Public Health Implications Chronic disease prevention and management must be based on behavioral change as a complement to medical intervention. Chronic disease prevention and management must be based on behavioral change as a complement to medical intervention.

5. Public Health Implications Poor nutrition costs more than $33 billion per year in medical care and $9 billion in lost productivity because of heart disease, cancer, stroke, and diabetes. Poor nutrition costs more than $33 billion per year in medical care and $9 billion in lost productivity because of heart disease, cancer, stroke, and diabetes.

6. Public Health Implications Smoking costs more than $75 billion per year in direct medical care and $80 billion per year in lost productivity. Smoking costs more than $75 billion per year in direct medical care and $80 billion per year in lost productivity.

7. Public Health Implications Physical inactivity in 2000 cost more than $76 billion. Physical inactivity in 2000 cost more than $76 billion.

8. Public Health Implications Obesity in 2000 cost $117 billion --- $61 billion in direct medical costs and $56 billion to lost productivity. Obesity in 2000 cost $117 billion --- $61 billion in direct medical costs and $56 billion to lost productivity.

9. Public Health Implications Diabetes in 2002 cost 92 billion in direct medical care and 40 billion in indirect cost (disability, work loss, and premature mortality). Diabetes in 2002 cost 92 billion in direct medical care and 40 billion in indirect cost (disability, work loss, and premature mortality).

10. Public Health Implications Estimated 6.3% of U.S. population has diabetes --- Estimated 6.3% of U.S. population has diabetes --- 5.2 million undiagnosed.

11. Public Health Implications By 2050 an estimated 29 million Americans are expected to have diagnosed diabetes. By 2050 an estimated 29 million Americans are expected to have diagnosed diabetes.

12. Public Health Implications Using 2002 cost estimates each case costs $13,243. Using 2002 cost estimates each case costs $13,243.

13. Public Health Implications Do the math Do the math $13,243 X 29 million = Health Care Costs Out of Control

14. Public Health Implications Diabetes does not impact all populations equally. Health disparities exist between racial groups and gender. Diabetes does not impact all populations equally. Health disparities exist between racial groups and gender.

18. Public Health Implications Morbidity and mortality change radically by age group. Morbidity and mortality change radically by age group.

21. What are the behavioral trends?

22. Obesity Trends* Among U.S. Adults BRFSS, 1985 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

23. Obesity Trends* Among U.S. Adults BRFSS, 1986 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

24. Obesity Trends* Among U.S. Adults BRFSS, 1987 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

25. Obesity Trends* Among U.S. Adults BRFSS, 1988 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

26. Obesity Trends* Among U.S. Adults BRFSS, 1989 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

27. Obesity Trends* Among U.S. Adults BRFSS, 1990 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

28. Obesity Trends* Among U.S. Adults BRFSS, 1991 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

29. Obesity Trends* Among U.S. Adults BRFSS, 1992 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

30. Obesity Trends* Among U.S. Adults BRFSS, 1993 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

31. Obesity Trends* Among U.S. Adults BRFSS, 1994 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

32. Obesity Trends* Among U.S. Adults BRFSS, 1995 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

33. Obesity Trends* Among U.S. Adults BRFSS, 1996 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

34. Obesity Trends* Among U.S. Adults BRFSS, 1997 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

35. Obesity Trends* Among U.S. Adults BRFSS, 1998 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

36. Obesity Trends* Among U.S. Adults BRFSS, 1999 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

37. Obesity Trends* Among U.S. Adults BRFSS, 2000 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

38. Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

39. (*BMI  30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%–14%15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002

40. (*BMI  30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%–14 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2003

41. 19961991 2003 Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003 (*BMI 30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14%15%–19% 20%–24% ≥25%

42. 2003 Tennessee Youth Risk Behavior Survey (YRBS)

43. Risk Behavior Implications 27% rode with a drinking driver during the past month 27% rode with a drinking driver during the past month

44. Risk Behavior Implications 41% drank alcohol during the past month 41% drank alcohol during the past month

45. Risk Behavior Implications 24% used marijuana during the past month 24% used marijuana during the past month

46. Risk Behavior Implications 36% had sexual intercourse during the past three months 36% had sexual intercourse during the past three months

47. Risk Behavior Implications 62% have tried cigarette smoking 62% have tried cigarette smoking

48. Risk Behavior Implications 28% smoked cigarettes during the past month 28% smoked cigarettes during the past month

49. Risk Behavior Implications 82% ate <5 servings of fruits and vegetables per day during the past 7 days 82% ate <5 servings of fruits and vegetables per day during the past 7 days

50. Risk Behavior Implications 76% participated in insufficient moderate physical activity 76% participated in insufficient moderate physical activity

51. Risk Behavior Implications 61% were not enrolled in a physical education class 61% were not enrolled in a physical education class

52. Risk Behavior Implications 15% were “at risk” for becoming overweight 15% were “at risk” for becoming overweight

53. Risk Behavior Implications 15% were “overweight” 15% were “overweight”

54. Percentage of Overweight U.S. Children and Adolescents is Soaring* * >95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts **Data from 1963-65 for children 6-11 years of age and from 1966-70 for adolescents 12-17 years of age Source: National Center for Health Statistics 18 Ages 12-19 Ages 6-11 5 4 16 0 2 4 6 8 10 12 14 16 1963- 70** 1971-741976-801988-941999- 2002

56. Why focus on diabetes? 1. Excessive morbidity and mortality 2. Comorbid relationship with other chronic illnesses 3. Resolve health disparities 4. Need for more effective patient self management strategies 5. Reduce the impact of health care economics.