Diabetes poses a significant public health challenge for the United States. Diabetes is a chronic disease that usually manifests itself as one of two major …
5
Diabetes
Co-Lead Agencies: Centers for Disease Control and Prevention
National Institutes of Health
Contents
Overview Page 5-3
Issues Page 5-3
Trends Page 5-4
Disparities Page 5-8
Opportunities Page 5-9
Interim Progress Toward Year 2000 Objectives Page 5-9
Healthy People 2010-Summary of Objectives Page 5-11
Healthy People 2010 Objectives Page 5-12
Related Objectives From Other Focus Areas Page 5-32
Terminology Page 5-33
References Page 5-34
Goal
Through prevention programs, reduce the disease and
economic burden of diabetes, and improve the quality of life for all
persons who have or are at risk for diabetes
Overview
Diabetes poses a significant public health challenge for the United States
Some 800,000 new cases are diagnosed each year, or 2,200 per day[i], [ii]
The changing demographic patterns in the United States are expected to
increase the number of people who are at risk for diabetes and who
eventually develop the disease Diabetes is a chronic disease that usually
manifests itself as one of two major types: type 1, mainly occurring
in
children and adolescents 18 years and younger, in which the body does not
produce insulin and thus insulin administration is required to sustain
life; or type 2, occurring usually in adults over 30 years of age, in which
the bodys tissues become unable to use its own limited amount of insulin
effectively While all persons with diabetes require self-management
training, treatment for type 2 diabetes usually consists of a combination
of physical activity, proper nutrition, oral tablets, and insulin
Previously, type 1 diabetes has been referred to as juvenile or insulin-
dependent diabetes and type 2 diabetes as adult-onset or noninsulin
dependent diabetes
Issues
The occurrence of diabetes, especially type 2 diabetes, as well as
associated diabetes complications, is increasing in the United States1, 2,
[iii] The number of persons with diabetes has increased steadily over the
past decade; presently, 105 million persons have been diagnosed with
diabetes, while 55 million persons are estimated to have the disease but
are undiagnosed This increase in the number of cases of diabetes has
occurred particularly within certain racial and ethnic groups[iv] Over the
past decade, diabetes
has remained the seventh leading cause of death in
the United States, primarily from diabetes-associated cardiovascular
disease While premenopausal nondiabetic women usually are at less risk of
cardiovascular disease than men, the presence of diabetes in women is
associated with a three- to four-fold increase in coronary heart disease
compared to nondiabetic females[v] In the United States, diabetes is the
leading cause of nontraumatic amputations approximately 57,000 per year or
150 per day; blindness among working-aged adults approximately 20,000 per
year or 60 per day; and end-stage renal disease ESRD approximately
28,000 per year or 70 per day[vi] See Focus Area 4 Chronic Kidney
Disease and Focus Area 28 Vision and Hearing
These and other health problems associated with diabetes contribute to an
impaired quality of life and substantial disability among people with
diabetes[vii] Dia-betes is a costly disease; estimates of the total
attributable costs of diabetes are around 100 billion 43 billion direct;
45 billion indirect[viii], [ix] Hospitalizations for diabetes-associated
cardiovascular disease account for the largest component of the direct
costs However, diabetes
management is occurring increasingly in the
outpatient setting, and more people with diabetes are using nursing home
facilities8, 9
Diabetes is a major clinical and public health challenge within certain
racial and ethnic groups where both new cases of diabetes and the risk of
associated complications are great4, [x]
These realities are especially disturbing given the validated efficacy and
economic benefits of secondary prevention controlling glucose, lipid, and
blood pressure levels and tertiary prevention screening for early
diabetes complications [eye, foot, and kidney abnormalities], followed by
appropriate treatment and prevention strategies[xi], [xii], [xiii],
[xiv], [xv], [xvi], [xvii] For many reasons, however, these scientifically
and economically justified prevention programs are not used routinely in
daily clinical management of persons with diabetes[xviii], [xix], [xx]
Diabetes is thus a wasteful disease Strategies that would lessen the
burden of this disease are not used regularly, resulting in unnecessary
illness, disability, death, and expense
Trends
The toll of diabetes on the health status of people in the United States is
expected to worsen before it
improves, especially in vulnerable, high-risk
populations-African Americans, Hispanics, American Indians or Alaska
Natives, Asians or other Pacific Islanders, elderly persons, and
economically disadvantaged persons Several factors account for this
chronic disease epidemic, including behavioral elements improper
nutrition, for example, increased fat consumption; decreased physical
activity; obesity; demographic changes aging, increased growth of at-risk
populations; improved ascertainment and surveillance systems that more
completely capture the actual burden of diabetes; and the relative weakness
of interventions to change individual, community, or organizational
behaviors1, 3, 7, [xxi] Several other interrelated factors influence the
present and future burden of diabetes, including genetics, cultural and
community traditions, and socioeconomic status SES In addition,
unanticipated scientific breakthroughs, the characteristics of the health
care system, and the level of patient knowledge and empowerment all have a
great impact on the disease burden associated with diabetes
Personal behaviors Westernization, which includes a diet high in fat and
processed foods as well as total
calories, has been associated with a
greater number of overweight persons in the United States when compared to
a decade ago, especially within certain racial and ethnic groups, for
example, African American females[xxii], [xxiii] Obesity, improper
nutrition including increased ingestion of fats and processed foods, and
lack of physical activity are occurring in persons under age 15 years
These behaviors and conditions may explain the increasing diagnosis of type
2 diabetes in teenagers[xxiv], [xxv] Increased television watching
associated with diminished physical activity also may contribute to the
emergence of type 2 diabetes in youth24, 25, [xxvi], [xxvii]
Demographics Diabetes is most common in persons over age 60 years[xxviii]
Increased insulin resistance and gradual deterioration in the function of
insulin-producing cells may account for this phenomenon As the population
in the United States ages, especially as the number of persons aged 60
years and older grows, an increase in the number of people with diabetes is
expected While studies indicate that aging itself may not be a major
factor in the substantial increase in the number of persons with
diabetes,21 present and
future prevention strategies for diabetes will be
associated with a greater lifespan for persons with diabetes[xxix]
Other changes in the US population can be expected to affect the number
of persons with diabetes By 2050, almost half of the population will be
other than white 53 percent white, 24 percent Hispanic, 14 percent African
American, and 8 percent Asian[xxx] Because these racial and ethnic groups
are at greater risk for diabetes and associated complications, and because
of rising levels of obesity and physical inactivity in the general
population, the number of persons with diabetes is expected to continue to
increase into the first few decades of the 21st century[xxxi]
Ascertainment Known as the hidden disease, diabetes is undiagnosed in an
estimated 5 million persons[xxxii], [xxxiii] In addition, complications
and health services associated with diabetes frequently are not recorded on
death certificates,[xxxiv], [xxxv] hospital discharge forms,[xxxvi]
emergency department paperwork, and other documents Much of this missing
burden of diabetes now is being captured due to improved surveillance and
data systems,[xxxvii] including boxes on data forms to indicate
the
presence of diabetes and screening programs for undiagnosed diabetes in
high-risk persons32 Thus, the real-but previously undocumented-burden of
diabetes is becoming better recognized
Limitations in programs to change behaviors Scientific evidence indicates
that secondary and tertiary prevention programs are effective in reducing
the burden of diabetes Yet changing the behaviors of persons with
diabetes, health care providers, or other individuals or organizations
involved in diabetes health care for example, health maintenance
organizations and employers is difficult Although many factors account
for these challenges,[xxxviii] more effective interventions will need to be
developed and implemented to improve the practice of diabetes care Several
other factors influence the present and future burden of diabetes,
including genetics, culture, SES, scientific discoveries, and the
characteristics of both chronic diseases and the health care system
Both type 1 and type 2 diabetes have a significant genetic
component[xxxix], [xl] For type 1 diabetes, genetic markers that indicate
a greater risk for this condition have been identified; they are sensitive
but not specific Type 2
diabetes, especially in vulnerable racial and
ethnic groups, may be associated with a thrifty gene40, [xli] Family and
twin studies demonstrate considerable influence of genetics for type 2
diabetes, but a specific genetic marker for the common variety of type 2
diabetes has not been identified The degree to which such genetic
indicators can be both validated and clinically available will determine
the effectiveness of primary prevention trials[xlii], [xliii]
Personal behaviors are influenced by beliefs and attitudes, and these are
greatly affected by community and cultural traditions[xliv], [xlv] In many
racial and ethnic communities, fatalism, use of alternative medicine,
desirability of rural living conditions, lack of economic resources, and
other factors will influence significantly both availability of health care
and the capabilities of persons with diabetes in handling their own care
Thirteen percent of the total US population speak a language at home
other than English Cultural and linguistic factors affect interactions
with health care providers and the system The degree to which diabetes
prevention strategies recognize and incorporate these traditions will
largely
determine program effectiveness[xlvi], [xlvii]
The public health and medical communities increasingly are recognizing the
influence of SES in the occurrence of new cases and progression of chronic
diseases[xlviii], [xlix], [l] Chronic diseases, such as diabetes, reflect
the social fabric of our society: the degree to which employment, financial
security, feelings of safety, education, and the availability of health
care are addressed and improved within the United States will influence the
likelihood of developing type 2 diabetes as well as effectively managing
both types of diabetes[li] For example, unemployment without access to
health insurance will substantially limit attention to and expenditures for
preventive health practices
Because acute infectious diseases were the dominant health threats during
the first half of the 20th century, a dichotomous view of health developed:
for example, people were either alive or dead, vaccinated or not
vaccinated Death and length of life were the most important markers of
disease burden and program effectiveness during those years Chronic
diseases, such as diabetes, pose different challenges because qualitative
terms such as doing better
are valid indicators of health improvement, as
are measures of quality of life and disability Further, a variety of
nonphysician health professionals for example, nurses or pharmacists and
nonhealth care professionals for example, faith or community leaders,
employers can be involved in critical decisions affecting chronic
diseases Diabetes, like other chronic conditions, is long term and is
affected by the environment where people live, work, and play For diseases
like diabetes, the accurate measurement of quality of life as an indicator
of program effectiveness and the incorporation of nonhealth professionals
at work or worship on the health team will influence the successes of
preventive treatment programs37, 45, 46
The rapidity and utility of scientific discoveries also will influence the
control of the diabetes burden In all aspects of scientific investigation,
important observations about diabetes will continue to occur These
scientific results will greatly influence diabetes prevention and
management,[lii], [liii], [liv] but any scientific study that is not
translated and used in daily practice ultimately is wasted10, [lv]
The availability of a responsive and effective
health care system will
determine access to quality care, especially in secondary and tertiary
prevention[lvi], [lvii] With the emergence of managed care, a person with
diabetes theoretically could receive effective, economical, and planned
preventive care that would minimize the diabetes burden[lviii] Several
additional changes need to occur within the managed care setting, however,
to maximize fully this theoretical opportunity for persons with diabetes,
including managed care 1 not denying access to potentially expensive
patients, 2 allowing adequate time for health professionals to interact
with patients, and 3 ensuring patient protection rights
In addition, the apparent movement toward primary care will affect diabetes
management and outcomes At present, about 90 percent of all persons with
diabetes receive continuous care from the primary care community This is
highly unlikely to change Thus, the degree that improved relationships can
be established be-tween diabetes specialists and primary care health
providers will determine the quality of diabetes care[lix]
People with diabetes spend a small percentage of their time in contact with
health professionals In addition to
family, friends, and work colleagues,
individual patient knowledge, beliefs, and attitudes affect diabetes
management and outcomes The ability to understand and influence
individual, community, and organizational behaviors will influence
significantly the success of preventive programs in diabetes[lx], [lxi],
[lxii]
Disparities
Gaps exist among racial and ethnic groups in the rate of diabetes and its
associated complications in the United States Certain racial and ethnic
communities, including African Americans, Hispanics, American Indians, and
certain Pacific Islander and Asian American populations as well as
economically disadvantaged or older people, suffer disproportionately
compared to white populations For example, the relative number of persons
with diabetes in African American, Hispanic, and American Indian
communities is one to five times greater than in white communities4 Deaths
from diabetes are 2 times higher in the African American population than
they are in the white population, and diabetes-associated renal failure is
25 times higher in the African American population than it is in the
Hispanic population1, 6, 7
Particularly within certain racial and ethnic
groups, there are four
potential individual reasons for the greater burden of diabetes:
Greater number of cases of diabetes If diabetes is more common, then more
amputations, death, and other complications from diabetes would be
expected
Greater seriousness of diabetes If hyperglycemia or other serious comorbid
conditions, such as high blood pressure or elevated blood lipids, are
present in certain racial and ethnic groups, a greater diabetes-related
disease burden will occur Many other factors could be involved, including
genetics and excess weight Greater seriousness of diabetes can be
determined by comparing, for example, death or amputation rates for
specific racial and ethnic diabetic groups with those rates in the general
diabetic population
Inadequate access to proper diabetes prevention and control programs If
proven diabetes services, such as self-management training programs or eye-
retina examinations, are not a part of routine diabetes care, then
effective programs to reduce the burden of diabetes will not be accessed
and used These essential diabetes services often are provided by
specialists Unfortunately, many diabetes at-risk groups reside in
medically
underserved areas or are without adequate insurance and thus do
not receive these types of preventive services
Improper quality of care If diabetes management services are available,
but the quality of that service is inadequate, prevention programs would
not be effective in reducing the burden of diabetes
Identifying the reasons for disparities in diabetes health outcomes is
important in tailoring programs to those specific areas where deficiencies
exist Collection of racial and ethnic health services data for all health
activities is critical to designate the reason for the greater disease
burden
Opportunities
Opportunities to meet the challenges of diabetes lie in four transition
points in the natural history of this disease and the preventive
interventions that target them: primary prevention, screening and early
diagnosis, access, and quality of care secondary and tertiary
prevention[lxiii]
The transition points and associated public health interventions are as
follows:
Transition Point 1: From No Diabetes to Diabetes Present although
not recognized Intervention, Primary Prevention
Transition Point 2: From Diabetes Not Recognized to Diabetes
Recognized but preventive diabetes care not provided
Intervention, Screening/Early Diagnosis
Transition Point 3: From No Care to Diabetes Care Applied
Intervention, Access
Transition Point 4: From Improper Care to Proper Care
Intervention, Quality of Care Secondary and Tertiary Prevention-
for example, glucose control and decreasing diabetes
complications
Each transition point represents a diabetes prevention and control
opportunity that is contained in the diabetes objectives of Healthy People
2010 Objectives are categorized as: 1 diabetes education, 2 burden of
disease new cases, existing cases, undiagnosed diabetes, death, pregnancy
complications, 3 macrovascular, microvascular, and metabolic
complications, 4 laboratory services lipids, glycosylated hemoglobin,
microalbumin measurements, 5 health provider services eye, foot, and
dental examinations, and 6 patient protection behaviors aspirin, self-
blood-glucose-monitoring These objectives measure both the processes and
outcomes of preventive diabetes programs
To improve the quality of diabetes care, the Diabetes Quality Improvement
Project DQIP-a joint public/private
effort-has identified a set of
measures to track critical performance measures of diabetes management
Through the Quality Interagency Coordination QuIC task force, Federal
agencies with health care responsibilities are collaborating to use DQIP to
better focus efforts to improve diabetes care
Interim Progress Toward Year 2000 Objectives
In Healthy People 2000, five diabetes-related objectives were included in a
group of objectives addressing chronic conditions linked by their potential
impact on quality of life and disability Of these five objectives, eye
examinations is moving toward the 2000 target Death from diabetes,
nonretinal diabetes complications, new cases of diabetes, and the number of
existing cases all are moving away from the 2000 targets Diabetes
education is increasing in frequency among persons with diabetes
These changes in direction need to be considered carefully with regard to
significance, causes, and implications The greater number of new cases of
ESRD among persons with diabetes may in part be due to ascertainment;
that is, persons with diabetes were not in the past but now are allowed
access to ESRD treatment programs Similarly, while new cases of type
2
diabetes truly may be increasing in association with obesity and
inactivity, a higher number of cases of diabetes also may reflect increased
efforts to screen for previously undiagnosed diabetes as well as decreased
deaths from such conditions as diabetic acidosis or amputations Thus, an
increased number of existing cases of type 2 diabetes may in part reflect
successes in other types of diabetes prevention programs
Note: Unless otherwise noted, data are from the Centers for Disease Control
and
Prevention, National Center for Health Statistics, Healthy People 2000
Review, 1998-99
Healthy People 2010-Summary of Objectives
Diabetes
|Number |Objective Short Title |
|5-1 |Diabetes education |
|5-2 |New cases of diabetes |
|5-3 |Overall cases of diagnosed diabetes |
|5-4 |Diagnosis of diabetes |
|5-5 |Diabetes deaths |
|5-6 |Diabetes-related deaths |
|5-7 |Cardiovascular disease deaths in persons |
| |with diabetes |
|5-8 |Gestational diabetes
|
|5-9 |Foot ulcers |
|5-10 |Lower extremity amputations |
|5-11 |Annual urinary microalbumin measurement |
|5-12 |Annual glycosylated hemoglobin measurement |
|5-13 |Annual dilated eye examinations |
|5-14 |Annual foot examinations |
|5-15 |Annual dental examinations |
|5-16 |Aspirin therapy |
|5-17 |Self-blood-glucose-monitoring |
Healthy People 2010 Objectives
5-1 Increase the proportion of persons with diabetes who
receive formal diabetes education
Target: 60 percent
Baseline: 45 percent of persons with diabetes received formal diabetes
education in 1998 age adjusted to the year 2000 standard population
Target setting method: Better than the best
Data source: National Health Interview Survey NHIS, CDC, NCHS
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Note: Age adjusted to the year 2000 standard population
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[lxiv][lxv]
5-2 Prevent diabetes
Target: 25 new cases per 1,000 population per year
Baseline: 35 new cases of diabetes per 1,000 population 3-year average
occurred in 1994-96 age adjusted to the year 2000 standard population
Target setting method: Better than the best retain year 2000 target
Data source: National Health Interview Survey NHIS, CDC, NCHS
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Note: Age adjusted to the year 2000 standard population
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Target: 25 overall cases per 1,000 population
Baseline: 40 overall cases including new and existing cases of diabetes
per 1,000 population occurred in 1997 age adjusted to the year
2000
standard
population
Target setting method: Better than the best retain year 2000 target
Data source: National Health Interview Survey NHIS, CDC, NCHS
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Note: Age adjusted to the year 2000 standard population
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Target: 80 percent
Baseline: 68 percent of adults aged 20 years and older with diabetes had
been diagnosed in 1988-94 age adjusted to the year 2000 standard
population
Target setting method: Better than the best
Data source: National Health and Nutrition Examination Survey NHANES,
CDC, NCHS
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[lxvi][lxvii][lxviii][lxix]
5-5 Reduce the diabetes death rate
Target: 45 deaths per 100,000 population
Baseline: 75 deaths per 100,000 population were related to diabetes in 1997
age adjusted to the year 2000 standard population
Target setting method: 43 percent improvement
Data source: National Vital Statistics System NVSS, CDC, NCHS
|Total Population, 1997 |Diabetes |
| |Deaths |
| |Rate per 100,000|
|TOTAL |75 |
|Race and ethnicity |
|American Indian or Alaska Native |107 |
|Asian or Pacific Islander |62 |
|Asian |DNC |
|Native Hawaiian and other Pacific |DNC |
|Islander |
|
|Black or African American |130 |
|White |70 |
| |
|Hispanic or Latino |86 |
|Mexican American |115 |
|Puerto Rican |87 |
|Cuban |39 |
|Not Hispanic or Latino |74 |
|Black or African American |133 |
|White |68 |
|Gender |
|Female |67 |
|Male |87 |
|Education level aged 25 years and older |
|Less than high school |48 |
|High school graduate |38 |
|At least some college |17 |
|Select populations |
|Age groups |
|Under 45 years |3 |
|45 to 64 years |64 |
|65 to 74
years |281 |
|75 years and older |673 |
DNA Data have not been analyzed DNC Data are not collected DSU Data
are statistically unreliable
Note: Age adjusted to the year 2000 standard population
5-6 Reduce diabetes-related deaths among persons
with diabetes
Target: 78 deaths per 1,000 persons with diabetes
Baseline: 88 deaths per 1,000 persons with diabetes listed anywhere on the
death certificate occurred in 1997 age adjusted to the year 2000 standard
population
Target setting method: 11 percent improvement
Data sources: National Vital Statistics System NVSS, CDC, NCHS; National
Health Interview Survey NHIS, CDC, NCHS
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Note: Age adjusted to the year 2000 standard population
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Target: 309 deaths per 100,000 persons with diabetes
Baseline: 343 deaths from cardiovascular disease per 100,000 persons with
diabetes occurred in 1997 age adjusted to the year 2000 standard
population
Target setting method: 10 percent improvement
Data sources: National Vital Statistics System NVSS, CDC, NCHS; National
Health Interview Survey NHIS, CDC, NCHS
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[lxx][lxxi][lxxii][lxxiii][lxxiv][lxxv][lxxvi][lxxvii][lxxviii][lxxix][lxxx]
[lxxxi]
5-8 Developmental Decrease the proportion of pregnant women with
gestational diabetes
Potential data source: National Vital Statistics System NVSS, CDC, NCHS
Studies of diabetes and pregnancy are consistent in their conclusions that
proper prepregnancy and pregnancy glycemia control and careful perinatal
obstetrical monitoring are associated with reduction in perinatal death and
congenital abnormalities More recently, the importance of good fetal and
neonatal nutrition in general, as well as in persons with diabetes, has
been emphasized[lxxxii], [lxxxiii], [lxxxiv], [lxxxv], [lxxxvi], [lxxxvii]
5-9 Developmental Reduce the frequency of foot ulcers
in persons with diabetes
Potential data source: National Health and Nutrition Examination Survey
NHANES, CDC, NCHS
5-10 Reduce the rate of lower extremity amputations in persons with
diabetes
Target: 18 lower extremity amputations per 1,000 persons with diabetes per
year
Baseline: 41 lower extremity amputations per 1,000 persons with diabetes
occurred in 1997 age adjusted to the year 2000 standard
population
Target setting method: 55 percent improvement
Data sources: National Hospital Discharge Survey NHDS, CDC, NCHS;
National Health Interview Survey NHIS, CDC, NCHS
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Note: Age adjusted to the year 2000 standard population
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Potential data source: Behavioral Risk Factor Surveillance System BRFSS,
CDC, NCCDPHP
Scientific evidence documents that with secondary and tertiary prevention,
microvascular complications of diabetes can be reduced substantially
Improved quality of life, decreased death rates, and reduced costs all can
result from improved clinical and public health diabetes prevention
strategies directed at microvascular
and metabolic complications from
diabetes Monitoring the consequences of these strategies through
reductions in mid- and end-stage microvascular complications needs to be an
important component in determining the effectiveness of national diabetes
activities In both type 1 and 2 diabetes, evidence now is established
firmly that microvascular and metabolic complications of diabetes can be
prevented through secondary glucose[lxxxviii], [lxxxix] and tertiary
screening and early treatment of complications[xc] prevention
strategies[xci], [xcii], [xciii], [xciv]
Improper nutrition, obesity, and inactivity appear to be significant risk
factors for the development of type 2 diabetes See Focus Area 19
Nutrition and Overweight and Focus Area 22 Physical Activity and Fitness
In addition, nutrition, weight, and physical activity components are
particularly critical in both glucose management and blood pressure and
lipid control in persons with diabetes These components are closely
related to abilities to control both micro- and macrovascular diabetic
complications Given the discouraging trends in obesity and physical
inactivity, these elements should be particularly and carefully monitored
in
persons with diabetes[xcv], [xcvi], [xcvii]
5-12 Increase the proportion of adults with diabetes who have
a glycosylated hemoglobin measurement at least once a year
Target: 50 percent
Baseline: 24 percent of adults aged 18 years and older with diabetes had a
glycosylated hemoglobin measurement at least once a year mean of data from
39 States in 1998; age adjusted to the year 2000 standard population
Target setting method: Better than the best
Data source: Behavioral Risk Factor Surveillance System BRFSS, CDC,
NCCDPHP
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| |
| |
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| | |
| | |
DNA Data have not been analyzed DNC Data are not collected DSU Data
are statistically unreliable
Note: Age
adjusted to the year 2000 standard population
Note: The table above may have continued from the previous page
[xcviii][xcix][c][ci][cii]
5-13 Increase the proportion of adults with diabetes who have an annual
dilated eye examination
Target: 75 percent
Baseline: 47 percent of adults aged 18 years and older with diabetes had an
annual dilated eye examination in 1998 age adjusted to the year 2000
standard
population
Target setting method: Better than the best
Data source: National Health Interview Survey NHIS, CDC, NCHS
Note: The table below may continue to the following page
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| |
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| | |
DNA Data have not been analyzed DNC Data are not collected DSU Data
are statistically unreliable
Note: Age adjusted to the year 2000 standard population
Note: The table above may have continued from the
previous page
Target: 75 percent
Baseline: 55 percent of adults aged 18 years and older with diabetes had at
least an annual foot examination mean value of data from 39 States in
1998; age adjusted to the year 2000 standard population
Target setting method: Better than the best
Data source: Behavioral Risk Factor Surveillance System BRFSS, CDC,
NCCDPHP
|Adults Aged 18 Years and Older |Annual Foot |
|With Diabetes, 1998 |Examination |
| |Percent |
|TOTAL |55 |
|Race and ethnicity |
|American Indian or Alaska Native |40 |
|Asian or Pacific Islander |57 |
|Asian |DNC |
|Native Hawaiian and other Pacific |DNC |
|Islander | |
|Black or African American |55 |
|White |55 |
| |
|Hispanic or Latino |56 |
|Not Hispanic or Latino |54
|
|Black or African American |54 |
|White |54 |
|Gender |
|Female |51 |
|Male |59 |
|Education level aged 25 years and older |
|Less than high school |46 |
|High school graduate |56 |
|At least some college |59 |
|Select populations |
|Age groups not age adjusted |
|18 to 44 years |53 |
|45 to 64 years |59 |
|65 to 74 years |56 |
|75 years and older |51 |
DNA Data have not been analyzed DNC Data are not collected DSU Data
are statistically unreliable
Note: Age adjusted to the year 2000 standard population
Note: The table above may have continued from the previous page
[ciii][civ][cv]
5-15 Increase the proportion of persons with diabetes who have at least an
annual dental
examination
Target: 75 percent
Baseline: 58 percent of persons aged 2 years and older with diagnosed
diabetes saw a dentist at least once within the preceding 12 months in 1997
age adjusted to the year 2000 standard population
Target setting method: Better than the best
Data source: National Health Interview Survey NHIS, CDC, NCHS
Note: The table below may continue to the following page
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|
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| | |
| | |
| |
| | |
| | |
| |
| |
| | |
| | |
| | |
| | |
DNA Data have not been analyzed DNC Data are not collected DSU Data
are statistically unreliable
Note: Age adjusted to the year 2000 standard population
Note: The table above may have continued from the previous
page
[cvi][cvii][cviii]
5-16 Increase the proportion of adults with diabetes who take aspirin at
least 15 times per month
Target: 30 percent
Baseline: 20 percent of adults aged 40 years and older with diabetes took
aspirin at least 15 times per month in 1988-94 age adjusted to the year
2000 standard population
Target setting method: Better than the best
Data source: National Health and Nutrition Examination Survey NHANES,
CDC, NCHS
Note: The table below may continue to the following page
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| | |
| |
| | |
| | |
| |
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| | |
| | |
DNA Data have not been analyzed DNC Data are not collected DSU Data
are statistically unreliable
Note: Age adjusted to the year 2000 standard population
Note: The table above may have continued from the previous page
Target: 60 percent
Baseline: 42 percent of adults aged 18 years and older with diabetes
performed self-blood-glucose-monitoring at least once daily mean of data
from 39 States in 1998; age adjusted to the year 2000 standard population
Target setting method: Better than the best
Data source: Behavioral Risk
Factor Surveillance System BRFSS, CDC,
NCCDPHP
Note: The table below may continue to the following page
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|
|
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| | |
| | |
| |
| |
| | |
| | |
| | |
| | |
DNA Data have not been analyzed DNC Data are not collected DSU Data
are statistically unreliable
Note: Age adjusted to the year 2000 standard population
Note: The table above may have continued from the previous page
[cix][cx][cxi][cxii][cxiii]
Related Objectives From Other Focus Areas
1 Access to Quality Health Services
1-1 Persons with health insurance
1-2 Health insurance coverage for clinical preventive services
1-3 Counseling about health behaviors
4 Chronic Kidney Disease
4-1 End-stage renal disease
4-2 Cardiovascular disease deaths in
persons with chronic kidney
failure
4-7 Kidney failure due to diabetes
4-8 Medical therapy for persons with diabetes and proteinuria
9 Family Planning
9-3 Contraceptive use
9-11 Pregnancy prevention education
12 Heart Disease and Stroke
12-1 Coronary heart disease CHD deaths
12-2 Knowledge of symptoms of heart attack and importance of calling
911
12-7 Stroke deaths
12-8 Knowledge of early warning symptoms of stroke
12-9 High blood pressure
12-10 High blood pressure control
12-11 Action to help control blood pressure
12-12 Blood pressure monitoring
12-13 Mean total cholesterol levels
12-14 High blood cholesterol levels
12-15 Blood cholesterol screening
12-16 LDL-cholesterol level in CHD patients
14 Immunization and Infectious Diseases
14-5 Invasive pneumococcal infections
14-29 Influenza and pneumococcal vaccination of high-risk adults
16 Maternal, Infant, and Child Health
16-6 Prenatal care
16-10 Low birth weight and very low birth weight
16-19 Breastfeeding
19 Nutrition and Overweight
19-1 Healthy weight in adults
19-2 Obesity in
adults
19-3 Overweight or obesity in children and adolescents
19-16 Worksite promotion of nutrition education and weight management
19-17 Nutrition counseling for medical conditions
22 Physical Activity and Fitness
22-1 No leisure- time physical activity
22-2 Moderate physical activity
22-3 Vigorous physical activity
22-6 Moderate physical activity in adolescents
22-7 Vigorous physical activity in adolescents
28 Vision and Hearing
28-1 Dilated eye examinations
28-5 Impairment due to diabetic retinopathy
28-10 Vision rehabilitation services and devices
Terminology
A listing of abbreviations and acronyms used in this publication appears
in Appendix H
Ascertainment: The processes and systems used to collect information and
data about a particular health condition, for example, written surveys,
telephone calls, electronic records, etc
Comorbidity: The presence of serious health conditions in addition to the
one being examined, for example, high blood pressure in people with
diabetes mellitus
Diabetes mellitus diabetes: A chronic disease due to either or both
insulin deficiency and resistance to insulin action, and
associated with
hyperglycemia elevated blood glucose levels Over time, without proper
preventive treatment, organ complications related to diabetes develop,
including heart, nerve, foot, eye, and kidney damage; problems with
pregnancy also occur Diabetes is classified into four major categories:
Type 1 diabetes: Previously called insulin-dependent diabetes mellitus
[IDDM] or juvenile-onset diabetes [JODM] represents clinically about 5
percent of all persons with diagnosed diabetes Its clinical onset is
typically at ages under 30 years Most often this type of diabetes
represents an autoimmune destructive disease in beta insulin-producing
cells of the pancreas in genetically susceptible individuals Insulin
therapy always is required to sustain life and maintain diabetes
control
Type 2 diabetes: Previously called non-insulin-dependent diabetes
mellitus [NIDDM] or adult-onset diabetes [AODM] is the most common form
of diabetes in the United States and the world, especially in certain
racial and ethnic groups and in elderly persons In the United States,
approximately 95 percent of all persons with diagnosed diabetes 105
million and almost 100
percent of all persons with undiagnosed 55
million diabetes probably have type 2 diabetes
Gestational diabetes mellitus GDM: Refers to the development of
hyperglycemia during pregnancy in an individual not previously known to
have diabetes Approximately 3 percent of all pregnancies are associated
with GDM GDM identifies health risks to the fetus and newborn and
future diabetes in the mother and offspring
Other types: Include genetic abnormalities, pancreatic diseases, and
medication use
Complications: Microvascular-small vessel abnormalities in the eyes and
kidneys; macrovascular-large vessel abnormalities in the heart, brain, and
legs; and metabolic-abnormalities in nerves and during pregnancy
Diabetic acidosis: A severe condition of diabetes Due to a lack of
insulin, the body breaks down fat tissue and converts the fat to very
strong acids The condition most often is associated with a very high blood
sugar and happens most often in poorly controlled or newly diagnosed type 1
diabetes
Direct costs: Costs associated with an illness that can be attributed to a
medical service, procedure, medication, etc Examples include payment for
an x ray;
pharmaceutical drugs, for example, insulin; surgery; or a clinic
visit
Formal diabetes education: Self-management training that includes a process
of initial individual patient assessment; instruction provided or
supervised by a qualified health professional; evaluation of accumulation
by the diabetic patient of appropriate knowledge, skills, and attitudes;
and ongoing reassessment and training
Indirect costs: Those costs associated with an illness that occur because
an individual cannot work at his or her usual job due to premature death,
sickness, or disability for example, amputation
Prevention: Primary-stopping or delaying onset of diabetes; secondary-early
identification and stopping or delaying onset of complications; tertiary-
stopping disability from disease and its complications
Thrifty gene: An idea which suggests that a thrifty gene is present in
people likely to develop type 2 diabetes It is speculated that thousands
of years ago, people with this thrifty gene could store food very
efficiently and thus survive long periods of starvation Now when
starvation is unusual, this thrifty gene tends to make people overweight
and thus prone to diabetes
Urinary microalbumin
measurement: A laboratory procedure to detect very
small quantities of protein in the urine, indicating early kidney damage
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managed care population-Colorado Behavioral Risk Factor Surveillance
System Morbidity and Mortality Weekly Report 46:1018-1023, 1997
[cxii] CDC Preventive-care knowledge and practices among persons with
diabetes mellitus-North Carolina Behavioral Risk Factor Surveillance
System, 1994-1995 Morbidity and Mortality Weekly Report 46:1023-1026,
1997
[cxiii] ADA Aspirin therapy in diabetes Diabetes Care 22S1:45-46, 1999
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Source:childrenwithdiabetes.com
