bers with diabetes healthier longer and help them minimize or More than 560,000 Kaiser Permanente members have diabetes, Adults with diabetes face a …

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Goal

Diabetes

Reduce preventable disease and economic burden associated with diabetes and improve the quality of life for all persons who have, or are at risk for, diabetes

Overview
Diabetes is a major public health problem in Kentucky Diabetes was the fifth leading cause of death in 2004, affecting an estimated 75 percent of the adult population Kentucky ranks seventh among the 50 states for the highest prevalence of diabetes 2003 The prevalence of diabetes has steadily risen since the mid-1990s A portion of this increase may be related to increased efforts to diagnose previously unrecognized diabetes or changes in the diagnostic criteria for diabetes Nevertheless, this upward trend is expected to continue into the near future because of population characteristics and the rising prevalence of certain lifestyle risk factors for the disease Prevalence of diabetes is highest among men, individuals of African American descent, those aged 65 and older, and those living in the Appalachian region of the state Death rates due to diabetes are also higher among men and African Americans in Kentucky In fact, the age-adjusted death rate due to diabetes for African Americans 147 per
100,000 in 2002 was almost twice the comparable rate for the white population 78 per 100,000 The medical complications of diabetes create an additional burden on the health care system in Kentucky Specific problems include diabetic ketoacidosis, non-traumatic lower extremity amputations, cardiovascular and cerebrovascular disease, and end-stage renal disease During 2002, there were 96,320 diabetes-related hospitalizations in the state Direct and indirect costs due to diabetes in the Commonwealth were estimated at 29 billion in 2002 These costs and the impact of diabetes on the population can be reduced through modification of lifestyle risks, early diagnosis, appropriate health care, and informed self-care

Summary of Progress
Progress is being made toward achieving the 2010 objectives Considerable improvement in the rate of lower extremity amputations has been made, with a decline from the 2000 baseline of 6 per 1,000 to 44 per 1,000 in 2002 The percent of adults who have a glycosylated hemoglobin measurement at least once a year has increased from the 2000 baseline of 829 percent to 869 percent in 2004 Significant improvement has also been achieved in persons with diabetes who
perform self-blood glucose monitoring daily, with an increase from 551 percent in 2000 to 617 percent in 2004 Behavioral Risk Factor Surveillance System BRFSS data indicate that persons with diabetes who take an aspirin a day or every other day has increased from 476 percent in 2000 to 55 percent in 2003 Progress was made in persons with diabetes who receive formal diabetes self-management training, increasing from 457 percent in 2000 to 488 percent in 2004 Reducing anomalies in infants of mothers with diabetes has improved from 266 per 1,000 in 1998 to 234 per 1,000 in 2002 In 2000 the percentage of persons with diabetes who had annual foot exams was 63 percent This percentage declined slightly to 62 percent in 2004

HK 2010 Mid-Decade Review

Diabetes

Progress has been slow, however, in decreasing the prevalence of diagnosed diabetes The rate has increased from 6 percent in 1996-98 to 75 percent in 2004 The diabetes death rate has also climbed from 76 per 100,000 in 1999 to 78 per 100,000 in 2002 The incidence rate for diabetes-related end stage renal disease ESRD has also increased In 1998, 119 per 100,000 persons with diabetes had ESRD The 2002 rate increased to 148 per
100,000 The percentage of annual flu vaccinations in persons with diabetes has shown a slight improvement from 52 percent in 1997 to 549 percent in 2004 BRFSS data showed that 755 percent of persons with diabetes had an annual eye exam in 2000 However, the percentage decreased to 705 percent in 2004

HK 2010 Mid-Decade Review

Diabetes

Progress toward Achieving Each HK 2010 Objective
Summary of Objectives for Diabetes 181 DELETED 182 Decrease the rate at which the prevalence of diagnosed diabetes is climbing so that it reaches no more than 6 percent of the population 18 years and older 183 DELETED 184R Limit the upward trend in the diabetes death rate to the 1999 baseline of 76 per 100,000 185 Slow the rise in deaths due to cardiovascular disease where diabetes is listed as either a supplemental cause of death or an existing condition to no more than 276 per 100,000 diabetic population 186 DELETED 187R Reduce the frequency of anomalies in infants of mothers with diabetes to no more than 2333 per 1,000 births 188R Maintain the frequency of foot sores lasting more than four weeks to no more than 13 percent among persons with diabetes 189 Reduce the frequency of lower extremity
amputation to 54 per 1,000 persons with diabetes 1810 DELETED 1811R Decrease the incidence of diabetes related ESRD that requires dialysis or transplantation to no more than 113 per 100,000 population 1812 DELETED 1813R Increase to 90 percent the proportion of persons with diabetes who have a glycosylated hemoglobin measurement A1C at least once a year 1814 DELETED 1815 Increase to 80 percent the proportion of persons with diabetes who have an annual dilated eye exam
R Revised objective

Baseline

HK 2010 Target

MidDecade Status

Progress

Data Source

50 1996-98

75 2004

BRFSS

76/100,000 1999 2833/ 100,000 1997

76/ 100,000 276/ 100,000

78/100,000 2002 3342/ 100,000 2002

No No

Vital Statistics Vital Statistics

2659/ 1,000 1998 Adults: 13 2000 6/ 1,000 2000 119/ 100,000 1998

2333/ 1,000 13

2343/ 1,000 2002 14 2003 44/ 1,000 2002 148/ 100,000 2002

Yes

Vital Statistics BRFSS

54/ 1,000

Target Achieved

HOSP and BRFSS

113/ 100,000

Tri-State Renal Network

Adults: 829 2000

869 2004

Yes

BRFSS

Adults: 755 2000

705 2004

BRFSS

HK 2010 Mid-Decade Review

Diabetes

Progress toward Achieving Each HK 2010 Objective
Summary of Objectives for
Diabetes 1816 Increase to 70 percent the proportion of persons with diabetes who have at least an annual foot exam 1817R Increase to 56 percent the proportion of persons with diabetes over 40 years of age that take aspirin daily or every other day 1818R Increase to 65 percent the proportion of persons with diabetes who perform self-blood glucose monitoring at least daily 1819R Increase to 498 percent the proportion of persons with diabetes who have received formal diabetes self-management training 1820 Increase to 80 percent the proportion of persons with diabetes who receive an annual influenza vaccination
R Revised objective

Baseline

HK 2010 Target 70 56

MidDecade Status 621 2004 55 2003

Progress

Data Source BRFSS BRFSS

Adults: 63 2000 476 2000

No Yes

Adults: 551 2000 Adults: 457 2000 Adults: 52 1997

617 2004 488 2004 549 2004

Yes

BRFSS

498