the debilitating effects of diabetes can be lessened by healthy nutrition and physical activity, 510% of all diabetes diagnoses, has no known. prevention …
Find the Facts Diabetes in NH
Updated January 2008
Find The Facts connects New Hampshire state and community leaders to resources needed to implement evidence-based policies and programs to address a critical public health issue We welcome your suggestions for improvement by either completing a short survey http://wwwnhhealthpolicyinstituteunhedu/ffsurvey or by contacting Laura Davie ldavie@unhedu
INTRODUCTION
Our Mandate
the debilitating effects of diabetes can be lessened by healthy nutrition and physical activity, and by early identification and conscientious management of the disease Promoting these good health practices is our responsibilityTogether, we can make a difference NH Governor John Lynch1
Diabetes Definition
Diabetes is a disorder whereby the body does not either produce or consume the hormone insulin correctly leading to high blood glucose levels High blood glucose levels impair the circulatory system putting individuals at risk for many serious health conditions including: heart disease, blindness, nerve, and kidney damage Several types of diabetes exist Type 1 diabetes, which accounts for 510 of all diabetes diagnoses, has no known prevention strategies Type 2
diabetes, which account for 9095 of all diabetes diagnoses, has known modifiable risk factors such as obesity and physical inactivity2 Hampshire children is unknown Prevalence of risk factors for diabetes seems to be on the rise among adults and children In 2006, approximately 61 of New Hampshire adults were classified as overweight or obese4 In 2005, only 33 of New Hampshire adults5 engaged in vigorous exercise 3 days per week The 2007 Youth Risk Behavior Survey of New Hampshire high school students reported 144 of students were at risk form becoming overweight and 117 were overweight The same survey reported that 47 of New Hampshire high school students were physically active for a total of 60 minutes per day on five or more of the past seven days6
NH Diabetes Prevalence
In NH, diabetes is a growing health concern The proportion of NH adults who reported having been told by their physician that they had diabetes rose from 45 in 1995 to 74 in 2006 3 Diabetes prevalence among New
The Cost of Diabetes
The medical care costs associated with diabetes in New Hampshire was estimated at over 600 million in 2006 8 In 2004, approximately 8,700,000 or about 55 of all health care
expenditures for New Hampshire state government employees was related to diabetes care7
NEW HAMPSHIRE DATA
The below table summarizes data and reports containing New Hampshire-specific diabetes related data For most of these resources, an expanded description with key information such as latest year available is included on New Hampshire Health Data Inventory wwwnhhealthdataorg
Resource
New Hampshire Mortality Data
Description
This data contains information about diabetesrelated deaths for NH residents of all ages State and sub-state level data is available provided confidentiality restrictions are met NH DHHS has also published a death report which stratifies the
Link
NH mortality data: http://wwwdhhsstatenhus/DHHS/HSDM/deathdatahtm Most recent death report: http://wwwdhhsstatenhus/dhhs/hsdm/library/dat 1
Produced by The NH Institute for Health Policy and Practice as part of the Citizens Health Initiative
Resource
Description
diabetes death rate by several variables
Link
a-statisticalreport/nh-deathshtm
NH Hospital Discharge Data: Inpatient, Outpatient, and Specialty Hospitals Behavioral Risk Factor Surveillance System BRFSS Data
These three data sets provide information
about diabetes related inpatient, emergency room, and specialty hospital visits Data is available for NH residents of all ages State and sub-state level data is available provided confidentiality restrictions are met BRFSS provides estimates about diabetes prevalence, risk factors, and clinical care indicators for adults 18 State-level data as well as data for selected city and/or county areas within NH are available on CDCs SMART BRFSS website NH DHHS also has available a report summarizing BRFSS data YRBSS provides state-level estimates about the prevalence of diabetes risk factors exercise, obesity, nutrition among NH high school students In 2007 a select number of schools implemented the YRBSS survey with their entire student body School-level reports from these data will be available in the future This survey provides state-level estimates about the prevalence for the diabetes risk factors of exercise and obesity for youth six to seventeen and ten to seventeen years respectively Report contains state-level data for diabetes prevalence/burden, risk factors, clinical care, and health care utilization indicators for NH adults 18 years Issue Brief provides updated statistics
including analysis of BRFSS diabetes related risk factors Healthy NH 2010 contains state-level baseline and 2010 benchmarks for diabetes clinical care indicators for adults and risk factors See nutrition/physical activity section for both adults and youth The Agency for Health Research and Quality provides state-level diabetes clinical care and disparities in health care utilization indicators for NH adults 18 Estimated costs associated diabetes for NH state govt employees are also provided Paper contains data on diabetes risk factors and clinical care indicators for African Descendents and Latinos 18 years living in Hillsborough County A full report from 2003 is also available
Http://wwwdhhsstatenhus/dhhs/hsdm/hospitaldischarge-datahtm
Smart BRFSS: http://appsnccdcdcgov/brfss-smart/indexasp Most recent BRFSS report available: http://wwwdhhsstatenhus/dhhs/hsdm/behavioral -riskhtm State YRBS Results: http://wwwedstatenhus/education/doe/organizati on/instruction/HealthHIVAIDS/youthriskhtm School Reports: Contact Jeffrey Metzger at NH DHHS JeffreyLMetzger@dhhsstatenhus
Youth Risk Behavior Survey YRBS
National Survey of Childrens Health Data NH Diabetes Data, 2005 Report and
Diabetes in NH Issue Brief, 2007
http://wwwcdcgov/nchs/about/major/slaits/nschhtm
http://wwwdhhsnhgov/dhhs/cdpc/library/datastatisticalreport/diabetes-datahtm
Healthy NH 2010
http://wwwhealthynh2010org
State Snapshot 2005–Focus Area: Diabetes
Link to diabetes focus area: http://20710320346/summary/diabmenuaspx?div 1stateNH Link to main site: wwwqualitytoolsahrqgov The Issue Brief and Full Report are available on the Minority Health Coalitions website under Research and Evaluation: http://wwwnhhealthequityorg/english/pro_recfm 2
Disparities in Health: Diabetes Prevention in
Produced by The NH Institute for Health Policy and Practice as part of the Citizens Health Initiative
Resource
NH: Issue Paper Teen Assessment Project TAP Manchester Diabetes Report Card
Description
TAP reports contain prevalence estimates for diabetes risk factors exercise, obesity for middle high school age youth Results are limited to NH school districts participating in the project Report card contains diabetes mortality, risk factor, and health care utilization indicators for Manchester adults and a mixture of youth age
brackets
Link
Http://extensionunhedu/4h/4hcydtaphtm
http://wwwmanchesternhgov/citygov/hlt/healthda tareportshtml
EVIDENCE-BASED INTERVENTIONS
The below table summarizes available evidence resources for interventions to prevent and treat diabetes
Intervention
Increase physical activity
Resource
Guide To Community Preventive Services: Physical Activity Guide to Community Preventive Services: Nutrition Guide to Community Preventive Services: Obesity Guide to Community Preventive Services: Diabetes New Hampshire Guidelines For Diabetes
Description
This 2001 chapter reviews the effectiveness of different informational, behavioral/social, and environmental/policy approaches to increasing physical activity
Link
http://wwwthecommunitygu ideorg/pa/defaulthtm
Improved nutrition
This 2005 chapter examines the effectiveness of school-based nutrition programs
http://wwwthecommunitygu ideorg/nutrition/defaulthtm
Weight Loss
This 2005 chapter reviews evidence for the effectiveness of school and work-site based obesity prevention programs Updated in 2005, this chapter reviews the effectiveness of health care interventions disease and case management and self-care approaches based in
different settings community, home, school, work, camp to manage diabetes Updated in January 2007, the report summarizes Am Diabetes Assoc clinical practice recommendations for screening, diagnosis, management, and complications associated with pre-diabetes and diabetes The portal offers educational tools for both the practicing clinician and the diabetes patient based on best practices in diabetes care and management Two printed guides are available: the ACP Diabetes Care Guide for health care professionals and Living With Diabetes: An Everyday Guide for You and Your Family for patients
http://wwwthecommunitygu ideorg/obese/defaulthtm
http://wwwthecommunitygu ideorg/diabetes/defaulthtm
Diabetes Management
http://wwwdhhsstatenhus/ DHHS/CDPC/LIBRARY/Best Practice/diabetes-carehtm
American College of Physicians Diabetes Portal
http://diabetesacponlineorg/
3 Produced by The NH Institute for Health Policy and Practice as part of the Citizens Health Initiative
NEW HAMPSHIRE PROGRAM IN ACTION
Updated outcomes data available
Monadnock Family Services of Keene is taking an innovated approach to combating risk factors associated with diabetes among those with severe mental illness
Studies show people with severe mental illness, such as schizophrenia, experience a higher prevalence of diabetes in addition to other chronic diseases and risk factors associated with diabetes[i], as well as live shorter lives by about 1025 years compared to the general population [ii] Initiated in 2004, the In-Shape program connects each participant with: a health mentor/personal trainer; access to free or low cost gym memberships, dance classes, yoga, tennis, and water exercises; nutrition and cooking classes; and a weight loss support group A nurse also guides participants in accessing health care and communicating with their Primary Care Provider The program now has reached 400 participants, 100 of whom are enrolled in an evaluation study undertaken by the Dartmouth Psychiatric Research Center Nine months after beginning the program, evaluation results showed: 1 2 3 Participants significantly increased the number of hours they reported exercising per week Participants significantly increased their overall activity and their participation in vigorous activities Participants were significantly more satisfied with their physical fitness 4 Participants reported having
significantly greater self-efficacy, or confidence, in social situations
In addition, in term of health status and functioning: 1 Approximately one-fifth of participants reduced their waist circumference by 10 or more centimeters or lowered their weight by 10 or more pounds Over one third reduced their systolic blood pressure by 10 or more mm Hg One-fourth with depression showed a 50 or greater reduction in depressive symptoms
2 3
The In-Shape Program serves as an innovative example for preventing or delaying the onset of diabetes among the high-risk population of the severely mentally ill The Program continues to expand its funding base and list of community partners providing program support To learn more about the In-Shape Program, contact Gail Williams, Program Coordinator, at 603 357-6878 Interested in learning about other diabetes risk reduction programs in action from across the US? Go to: Exemplary State Programs to Prevent Chronic Disease Promote Health Report Diabetes Chapter: http://wwwcdcgov/nccdphp/publications/exemplary/ pdfs/Diabetespdf
KEY STATE AND LOCAL CONTACTS
New Hampshire Diabetes Education Program NHDEP: Through its work this New Hampshire Dept of Health
and Human Services NH DHHS program strives to prevent or postpone the onset of diabetes-related health problems by facilitating the use of diabetes care guidelines and coordinating statewide diabetes prevention efforts To contact the NHDEP, go to http://wwwdhhsnhgov/DHHS/CDPC/dephtm or call 1-800-852-3345 ext 5173 New Hampshire Diabetes Educators: A local diabetes educator may be able to provide insight into diabetes issues for and programs in your community To find a diabetes educator in your area, go to http://wwwnhadeorg/indexphp/directory Public Health Network PHN Coordinators: New Hampshire currently maintains 14 regional networks working on the public health and emergency preparedness needs of towns contained within their region PHN coordinators may be able to provide links to local diabetes contacts and efforts within their PHN region To see if your town is covered by a PHN, and for coordinator contact information, go to: http://wwwnhphnorg Lighten Up New Hampshire: This website provides research-based education and information aimed at the general public, communities, and professionals wwwlightenupnhorg
4 Produced by The NH Institute for Health Policy and Practice as part
of the Citizens Health Initiative
RELATED STATE POLICY AND PLANNING
New Hampshire Action Plan for Diabetes: This document provides a state-level blueprint to guide diabetes programs, funding, policies, and activities To obtain a copy of the plan, contact the New Hampshire Diabetes Education Program at 800 852-3345 Ext 5173 Statewide Healthy Eating and Active Living HEAL Initiative: The HNHfoundation, in conjunction with foundations, state agencies and private and public partners, provided support for a planning and implementation process to address overweight and obesity in New Hampshire Interventions addressing policy, practice and communication were identified for six sectors: businesses and worksites, schools, health care industry, communities and municipalities, food and recreation industries, and individuals and families, and can be found in the HEAL Action Plan A copy of the plan including priorities, recommendations, related resources, and up to date HEAL information are at wwwlightenupnhorg click on the HEAL logo Diabetes-related State Legislation: The New Hampshire Public Health Association NHPHA has released it 2008 Priorities Report which includes two diabetes-related
risk factors: lack of physical activity and poor nutrition In addition, NHPHAs Policy Committee monitors public health including diabetes-related legislation The NHPHA website wwwnhphaorg provides a link the 2008 Priorities Report To learn more about legislation NHPHA is tracking, use the contact us feature on the NHPHA website to reach the Policy Committee
1 2
To be released report NH Diabetes Data, 2004 Concord: NH Department of Health and Human Services National Diabetes Fact Sheet United States 2005, [Available at http://wwwcdcgov/diabetes/pubs/pdf/ndfs_2005pdf] Centers for Disease Control and Prevention [2006, Accessed April 19] Behavioral Risk Factor Surveillance System, [Available at http://appsnccdcdcgov/brfss/index] Centers for Disease Control and Prevention [2008, Accessed Jan 15] Behavioral Risk Factor Surveillance System, [Available at http://appsnccdcdcgov/brfss/index] Centers for Disease Control and Prevention [2008, Accessed Jan 15] Behavioral Risk Factor Surveillance System, [Available at http://appsnccdcdcgov/brfss/index] Centers for Disease Control and Prevention [2008, Accessed Jan 28] 2007 Youth Risk Behavior Survey Result [Available at
http://wwwedstatenhus/education/doe/organization/instruction/HealthHIVAIDS/youthriskhtm ] New Hamphsire Department of Education [2008, Accessed Jan 15] State Snapshots 2005 from the National Healthcare Quality Report, [Available at http://20710320346/summary/diabexpaspx?div1stateNHcompxlvl11] Agency for Healthcare Research and Quality [2006, Accessed April 19]
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6
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8 The Estimated Prevalence and Cost of Diabetes in New Hampshire, [Available at http://wwwdiabetesorg/advocacy-andlegalresources/cost-of-diabetesresultsjsp?stateNewHampshiredistrict0DistNameNewHampshire28EntireState29] American Diabetes Association [2008, Accessed Feb 13]
5 Produced by The NH Institute for Health Policy and Practice as part of the Citizens Health Initiative
Source:direct-ms.org
