1. Assessing Changes in Diabetes Management and Diabetes Complications in Utah Ladene Larsen, RN Barbara Larsen, RD, MPH William Stinner, Ph.D. Sandra Assasnik, MA Brenda Ralls, Ph.D.

2. The Burden of Diabetes Diabetes is the 4th leading cause of death from chronic disease Diabetes costs the nation over $100 billion annually Diabetes increases the risk of heart disease, kidney failure, blindness, and amputation

3. Effective Diabetes Management Can: Reduce blindness by 50% Reduce lower-extremity amputation by 50% Reduce kidney disease by 50% Reduce heart disease and stroke by 25%

4. Methods Surveys targeting Utahns with diabetes were conducted in 1987, 1991, and 1997 Ages ranged from 3 to 93 Over 200 respondents were included at each wave of the survey

8. Decreasing Age at Diagnosis of Diabetes by Gender: Utahns With Diabetes Survey, 1987, 1991 and 1997

9. Percent of Utahns With Diabetes Who Used Insulin: 1987-1997

10. Percent of Utahns With Diabetes Who Used Oral Meds: 1987-1997

11. Percent of Utahns with Diabetes Who Used Both Insulin and Oral Meds: 1987- 1997

12. Insurance Coverage Among Utahns with Diabetes

13. Percent of Utahns with Diabetes Who Had Health Insurance: 1987-1997

14. Access to Provider Services Among Utahns with Diabetes Who Were Covered by Insurance: 1987-1997

15. Complications Among Utahns With Diabetes

16. Percent of Utahns with Diabetes with LEAs: 1987-1997

17. Percent of Utahns with Diabetes Who Were on Dialysis: 1987-1997

18. Percent of Utahns with Diabetes Who Had Diabetic Retinopathy: 1987-1997

19. Percent of Utahns with Diabetes Who Were Referred for Dilated Eye Exam: 1987-1997

20. Percent of Utahns with Diabetes Who Had High Blood Pressure: 1987-1997

21. Percent of Utahns with Diabetes With Angina: 1987-1997

22. Percent of Utahns with Diabetes, Who Had High Blood Pressure, by Age, With and Without Diabetes: Utah Health Status Survey, 1996

23. Percent of Utahns with Diabetes, Who Had High Cholesterol Levels, by Age, With and Without Diabetes: Utah Health Status Survey, 1996

24. Percent of Utahns Who Had Cardiovascular Disease, by Age, With and Without Diabetes: Utah Health Status Survey, 1996

25. Provider Care Among Utahns With Diabetes

26. Primary Care Providers for Utahns with Diabetes: Urban and Rural Areas, 1997 Urban Rural

27. Patient-Doctor Communication Patterns at Routine Visits for Utahns with Diabetes: 1987-1997

28. Percent of Utahns with Diabetes Who Received Provider Services During Routine Visits: 1987-1997

29. Differences at Routine Check-ups Between General or Family Practice Physicians and Internists: 1997

30. Differences in Doctor-Patient Communication Between General or Family Practice Physicians and Internists: 1997

31. Self-Management Among Utahns With Diabetes

32. Percent of Utahns with Diabetes Who Checked Own Feet and Glucose: 1987-1997

33. Percent of Utahns with Diabetes Who Used Meal Plan 1987-1997

34. Percent of Utahns with Diabetes Who Exercised: 1987-1997

35. Percent of Utahns with Diabetes Who Smoked: 1987-1997

36. Percent of Utahns with Diabetes Who Were Obese (BMI>=30 kg/m 2 ): 1987-1997

37. Conclusions: Age of diagnosis of diabetes is declining Use of pharmaceuticals is increasing Insurance coverage is increasing Prevalence of serious complications is increasing Quality of provider care is improving Patients are becoming more responsible for their own management of diabetes

38. Implications We need to provide better information on diabetes management protocol to general and family practitioners Increasing obesity may be the greatest obstruction to seeing reductions in secondary complications from diabetes and may be off-setting all the other gains made

39. “Diabetes is a disease about which we can do a great deal, but only when those affected are informed and empowered to take the kind of control of this disease that is now possible.” Dr. James R. Gavin III, MD Chair, African-American Program

40. Contact Information : Brenda Ralls Utah Diabetes Control Program Bureau of Health Promotion Utah Department of Health Salt Lake City, UT 84114-2107 bralls@doh.state.ut.us (801) 538-6083