Diabetes Treatments

This figure represents a 35% increase in the prevalence of diabetes, a benchmark measure, Healthy People 2010 diabetes objective measures, where …

Introduction
Diabetes in Idaho is steadily increasing Since 1997, diabetes has gone from 40 to 54 in 2001 This figure represents a 35 increase in the prevalence of diabetes, a figure that matches a national increase in the prevalence of diabetes The cost of treating diabetes is also increasing The estimated annual economic cost of diabetes in Idaho is 468 million as of 2001 direct and indirect costs The 1997-2001 Trend Report provides a snapshot of the impact diabetes has had in Idaho from 1997-2001 and provides a measure of how diabetes is managed As a benchmark measure, Healthy People 2010 diabetes objective measures, where applicable, are included in this report Trend data are also available in some categories for the seven Idaho district health departments Data are from the Idaho Behavioral Risk Factor Surveillance System BRFSS, a statewide, random telephone survey conducted annually with an average of 4,900 adults over the age of 18 Throughout this report, charts are provided with 95 percent confidence intervals Confidence intervals are simply a range of numbers that indicate a 95 percent assurance that the numerical estimates fall between the high and low ranges listed These
data are used by the Idaho Diabetes Prevention and Control Program DPCP and partners to plan programs, work with health systems, support community interventions, and develop health communication messages The Idaho DPCP is funded by The Centers for Disease Control and Prevention CDC through a cooperative agreement with the Idaho Department of Health and Welfare In partnership with CDC, the Idaho DPCP addresses seven National Diabetes Objectives that are supported by clinical and translation research outcomes These objectives include: 1 2 3 4 5 6 7 Conduct surveillance Increase utilization of A1c testing Increase the rate of foot exams Increase the rate of eye exams Increase the rate of flu and pneumonia vaccinations Reach disparate populations Develop wellness linkages for physical activity, nutrition, healthy weight and smoking cessation

To address these objectives, the DPCP works to develop strategies that monitor health, mobilize partnerships, link people to care, facilitate public and professional awareness about diabetes, and evaluate programs and outcomes The goals of the DPCP are to prevent diabetes and to help people who have diabetes live a healthier life

Table of
Contents
Age and Gender 3 Foot Care 9 Self-Monitoring Blood Glucose 11 Dental Care 13 Dilated Eye Exams 15 Immunization 17 Cholesterol Screening 19 High Cholesterol 21 Overweight 22 Hypertension 23 Cigarette Smoking 24 Physical Activity 26 Quality of Life 28 Diabetes Education 29 References 31

2

Idaho Diabetes Management Trends - Age and Gender
There is evidence that diabetes is increasing among younger age groups at a faster rate than the traditional older age groups Additionally, prevalence among women increased over the following three age groups: 18-34, 35-54 and 55 and older These data are consistent with the findings that the prevalence increase in Idaho has been primarily driven by women The BRFSS data is used to examine four separate areas: age groups geographically by health departments, age groups statewide as a whole, gender and by both age and gender combined

District Health Departments
There are seven district health departments in Idaho Within each district there are several counties served It is worthy to note that public health district 7 was the only district to show a significant upward linear trend among adults that had been told they had
diabetes although it should be noted that lack of an upward trend in other districts may be a result of smaller sample sizes All public health districts in Idaho saw an increase in the prevalence of diabetes between 1997 and 2001
Boundar y

Bonner

1
Koot enai Benewah Shoshone

Lat ah Clear wat er

Nez Perce Lewis

2
Idaho

Lemhi Adams

Valley

Washingt on

4
Boise Ada Elmor e

7
Cust er Clar k Fremont Jef f erson Madison Tet on

Payet t e Gem

Canyon Blaine

But t e Camas Bonnev ille

5 3
Owyhee Twin Falls Cassia Gooding Lincoln Jer ome Minidoka Power

Bingham

6
Bannock Oneida

Car ibou

Bear Lake Franklin

District 1
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

District 1 39 49 63 55 54

Lower 23 30 43 38 36

Upper 54 67 83 72 72

Note: Public Health District 1 includes Boundary, Bonner, Benewah, Kootenai, and Shoshone counties

3

District 2
95 Confidence Intervals

Year 1997 1998 1999 2000 2001 District 3

District 2 28 42 48 42 42

Lower 15 27 32 38 26

Upper 42 58 64 76 57

Note: Public Health District 2 includes Latah, Nez Perce, Clearwater, Lewis, and Idaho counties

95 Confidence Intervals

Year 1997 1998 1999 2000 2001 District 4

District 3 51 46 57 60
61

Lower 34 28 38 42 41

Upper 68 63 76 79 81

Note: Public Health District 3 includes Adams, Washington, Payette, Gem, Canyon, and Owyhee counties

95 Confidence Intervals

Year 1997 1998 1999 2000 2001 District 5

District 4 34 38 40 37 53

Lower 19 22 24 20 35

Upper 49 53 56 53 70

Note: Public Health District 4 includes Valley, Boise, Ada, and Elmore counties

95 Confidence Intervals

Year 1997 1998 1999 2000 2001

District 5 48 53 44 50 50

Lower 31 29 29 32 32

Upper 65 76 60 67 67

Note: Public Health District 5 includes Camas, Blaine, Gooding, Lincoln, Jerome, Minidoka, Twin Falls, and Cassia counties

District 6
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

District 6 44 50 49 59 64

Lower 27 32 28 40 44

Upper 61 69 71 77 83

Note: Public Health District 6 includes Butte, Bingham, Power, Bannock, Oneida, Caribou, Franklin, and Bear Lake counties

4

District 7
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

District 7 40 28 39 48 57

Lower 25 17 24 31 39

Upper 56 40 53 65 74

Note: Public Health District 7 includes Lemhi, Custer, Clark, Fremont, Jefferson, Madison, Teton, and Bonneville counties

Diabetes and Age
Type 1 diabetes usually occurs in
children and adults under age 30 It develops when the bodys immune system attacks the insulin-producing cells of the pancreas However, about 90 percent of diabetes in the US is type 2 diabetes It is most common in adults over age 40 Type 2 diabetes occurs when the cells do not use insulin properly and the pancreas is not producing enough insulin1
Age Distribution of Idaho Adults Diagnosed With Diabetes 1997 and 2001 80 1997 Percent of Adults 60 2001

40

20

0 18-34 35-54 Age Groups 55

In 1997, adults 65 and older represented 52 percent of all diagnosed diabetes cases in Idaho, but in 2001 only 41 percent of adults with diagnosed diabetes were 65 or older

95 Confidence Intervals

Year 1997 1998 1999 2000 2001

18-34 09 07 03 12 15

Lower 03 01 00 06 09

Upper 14 12 05 18 21

5

95 Confidence Intervals

Year 1997 1998 1999 2000 2001

35-54 22 32 32 34 39

Lower 15 23 23 26 28

Upper 29 41 41 42 49

95 Confidence Intervals

Year 1997 1998 1999 2000 2001

55 99 96 116 107 116

Lower 81 77 96 88 97

Upper 117 114 135 127 135

Percent of Adults 18 Who Have Been Told They Have Diabetes 20 Year Age Groups

20

18-34 35-54 55

15
Percent of Adults

10

5

0 1997 1998 1999 2000 2001

When
looking at the age groups 18-34, 35-54 and 55 and older, prevalence has increased in magnitude across all age groups, but has only significantly increased since 1997 among adults 18-34 years of age

Diabetes and Gender
Type 2 diabetes is more prevalent among women than men, making prevention and early detection particularly important in the treatment of women Major areas of health care concern for women with diabetes include cardiovascular disease, mental health, infections, and contraception and fertility Knowledge of lifespan issues from adolescence through menopause is crucial to the management of women with diabetes10
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Male 45 47 48 46 52

Lower 35 36 38 36 41

Upper 56 58 59 57 62

6

Diabetes by Gender and Age
Women with diabetes have special health care concerns that must be addressed by members of the clinical management team Although the incidence of type 1 diabetes is similar for men and women, the prevalence of type 2 diabetes is higher among women, particularly after the age of 6510

Year 1997 1998 1999 2000 2001

Males 18-34 13 06 03 10 14 Males 35-54 23 31 42 29 33 Males 55 118 118 111 114 124

95 Confidence
Intervals

Lower 03 00 00 01 04

Upper 22 15 06 19 23

95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower 12 19 25 18 18

Upper 34 43 59 40 47

95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower 86 84 84 81 94

Upper 150 151 138 146 154

Percent of Adult Males 18 Who Have Been Told They Have Diabetes 20 Year Age Groups 1997-2001 20 Percent of Adults 15 10 5 0 1997 1998 1999 2000 2001 18-34 35-54 55

The change among men has been more modest with no significant upward trend detected across any of the twenty-year age groups

7

Year 1997 1998 1999 2000 2001

Females 18-34 05 07 03 14 17 Females 35-54 21 33 22 39 45 Females 55 84 78 119 102 110

95 Confidence Intervals

Lower 00 00 00 06 07

Upper 09 14 06 23 26

95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower 12 21 13 26 30

Upper 29 46 31 51 60

95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower 64 58 93 79 85

Upper 103 97 146 125 134

Percent of Adult Females 18 Who Have Been Told They Have Diabetes 20 Year Age Groups 1997-2001 20 15 10 5 0 1997 1998 1999 2000 2001 18-34 35-54 55

Diabetes has significantly increased among women since 1997 Female prevalence has increased an average of
13 percent per year compared to a 4 percent increase among men

Percent of Adults

8

Idaho Diabetes Management Trends - Foot Care
Amputation and foot ulcers are a common medical risk factor and a common cause of disability for people with diabetes In many cases, foot complications are manageable and preventable with regular foot exams and daily self foot care In Idaho, in 2001, 87 percent of adults with diabetes checked their own feet at least one time per week5 In 2001, 118 percent of respondents with diabetes stated that at sometime in the last year they experienced sores on their feet that took four or more weeks to heal5

American Diabetes Association Clinical Practice Recommendations
An annual comprehensive foot examination is recommended for patients with diabetes to identify risk factors predictive of ulcers and amputations A visual inspection of patients feet at each routine visit should be performed1

The HP2010 Objective
To ensure that 75 of adults with diabetes aged 18 or older receive at least one foot examination annually3
Having an Annual Foot Exam 606 542 586 581 644
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
529 457 511 509 578

Upper
684 626
661 654 711

Percent of Adults 18 With Diabetes Who Have Had a Foot Exam, Past Year 1997-2001

100 80 Percent of Adults 60 40 20 0 1997 1998 1999 2000 2001

There has been no statistically significant change in the rate at which adults in Idaho with diabetes have received at least an annual foot exam since 1997

9

National Objectives and Idaho Annual Foot Exam Data , Age-Adjusted
100 Percent of Adults 80 60 40 55 20 0 1998 National Baseline 1998 Idaho 2001 Idaho HP2010 Objective 53 58 75

Using age-adjusted estimates, Idaho is similar to the national baseline estimate for the rate of foot exams The 2001 age-adjusted foot exam estimate is 58 percent in Idaho5

10

Idaho Diabetes Management Trends Self-Monitoring Blood Glucose SMBG
Glycemic control is critical to the management of diabetes and preventing diabetes related health complications For patients with Type 1 diabetes, the consensus is selfmonitoring of blood glucose SMBG levels is optimal if performed 3-4 times daily1 No consensus has been reached on a recommended frequency of SMBG for Type 2 diabetes patients, but frequency should be sufficient to reach and maintain normal glucose levels1 SMBG is recommended for all
patients using insulin, which comprise 285 percent of adults with diabetes in Idaho in 2001

American Diabetes Association Clinical Practice Recommendations
Most individuals with diabetes should achieve and maintain glycemic controls through daily self-monitoring of blood glucose levels1

The HP2010 Objective
To increase the proportion of adults who perform self-blood glucose monitoring at least once daily3
Monitoring Blood Glucose at Least Daily 531 504 556 492 582
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
451 422 483 418 512

Upper
611 585 630 565 651

There has been no statistical change in the rate at which adults residing in Idaho with diabetes have performed daily SMBG since 1997

11

Percent of Adults 18 With Diabetes Who SMBG Levels at Least Daily 19972001 75

Percent of Adults

50

25

0 1997 1998 1999 2000 2001

Comparing Idaho to national estimates based on age-adjusted 2001 BRFSS data, Idaho 63 percent has already exceeded the Healthy People 2010 objective of 60 percent3

12

Idaho Diabetes Management Trends Dental Care
Although periodic oral examinations are not included as a standard of care, periodontal disease and diabetes are interrelated
There are links between periodontal disease and hyperglycemia that complicate diabetes control Diabetes increases the risk of oral health conditions with symptoms such as chronic dry mouth and soft tissue lesions in the mouth and mucous areas Treatment guidelines issued by the Centers for Disease Control and Prevention CDC recommend that people with diabetes see a dentist at least once every 6 months, and visits should be more frequent if periodontal disease is present2

American Diabetes Association Clinical Practice Recommendations
Although periodic oral examinations are not included as a standard of care, periodontal disease and diabetes are interrelated

The HP2010 Objective
To increase the proportion of persons with diabetes who have at least an annual dental examination to 753
Having at Least an Annual Dental Visit 557 NA 542 NA 563
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
477 NA 468 NA 494

Upper
636 NA 617 NA 633

Percent of Adults 18 With Diabetes Who Have Had a Dental Visit, Past Year 1997-2001

75

Percent of Adults

50

25

0
1996 1997 1998 1999 2000 2001 2002

There has been no statistical change in the rate at which Idaho adults with diabetes
have received at least an annual dental exam since 1997 Rate of dental visits in the past year have remained constant over the past 5 years among adults residing in Idaho with diabetes

13

National, Idaho and Healthy People 2010 , Age-Adjusted Dental Exam Data
100 80 Percent of Adults 60 40

75 54 53 53

20 0 1997 Idaho 2001 Idaho HP2010 1998 National Objective Baseline

Sixty-five percent of people without diabetes visit the dentist annually Using 2001 data, adults with diabetes were less likely to have visited a dentist in the past year using an age-adjusted comparison Sixty-six percent of adults without diabetes had visited a dentist in the previous year compared to 563 percent of adults with diabetes Even though people with diabetes were likely to visit a dentist, they were equally likely to have had dental insurance between the ages of 18-64 and Medicare if aged 65 and older The low percentage of adults 65 and over reflects both the lack of dental coverage through Medicare as well as the lower employment rate of this age group Comparing Idaho to national estimates based on age-adjusted dental exam data, Idaho 53 percent is just below the 1998 national baseline 54
percent

14

Idaho Diabetes Management Trends Dilated Eye Exams
Diabetic retinopathy is a disease that is very specific to patients with both type 1 and type 2 diabetes Diabetic retinopathy is the leading cause of blindness among adults age 20-74 Blindness because of diabetes is a result of distortion of blood vessel growth on the retina, bleeding from newly formed blood vessels resulting from retinopathy, or retinal detachment 1 Time is the most critical risk factor for the onset of retinopathy After 20 years of living with diabetes nearly all individuals with type 1 diabetes have some form of retinopathy and more than 60 percent of individuals with type 2 diabetes experience symptoms1 As of 2001, 146 percent of adults residing in Idaho with diabetes had lived with retinopathy for 20 years or more5

American Diabetes Association Clinical Practice Recommendations
A comprehensive dilated eye exam annually or more frequently is recommended if retinopathy is progressing1

The HP2010 Objective
Increase the proportion of adults with diabetes who have an annual dilated eye examination to 75 percent3
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Having an Annual Eye Exam 735
604 653 564 618

Lower
670 522 582 491 550

Upper
800 686 723 636 686

Percent of Adults 18 With Diabetes Who Had an Annual Dilated Eye Exam 1997-2001 80

Percent of Adults

60

40 184 20 192

0 1997 1998 1999 2000 2001

There has been a decrease in the rate at which adults residing in Idaho with diabetes have received at least an annual dilated eye exam since 1997

15

National Objectives and Idaho Annual Eye Exam Data, Age-Adjusted
80 Percent of Adults 60 40 20 0 1998 National Baseline 1998 Idaho 2001 Idaho HP2010 Objective 47 57 56

75

In Idaho there is no association between being 65 or older and having a dilated eye exam In 2001, 587 percent of adults aged 18 to 64 had an annual dilated eye exam compared to 664 percent of those 65 and older5

16

Idaho Diabetes Management Trends Immunizations
Age and the presence of chronic diseases are risk factors for increased hospitalization due to influenza or pneumonia Flu and pneumococcal vaccinations are a safe way all persons with diabetes, who are 6 years of age or older, can reduce the chances of serious health complications due to flu or pneumonia1

American Diabetes Association Clinical Practice Recommendations
It is recommended
that an annual influenza vaccine be given to all patients with diabetes 6 years of age or older At least one lifetime pneumococcal vaccination for adults with diabetes is recommended A one-time revaccination is recommended for individuals over 64 years of age previously immunized when they were younger than 65 years of age if the vaccine was administered more than 5 years ago1

The HP2010 Objective
Increase the proportion of adults who receive annual influenza and one lifetime pnuemococcal vaccination to 60 percent f or ages 18-64 and 90 percent for ages 65 and over3

Year 1997 1998 1999 2000 2001

Having a Flu Shot, Past Year 702 NA 591 NA 601

95 Confidence Intervals

Lower
634 NA 517 NA 533

Upper
770 NA 665 NA 668

There has been a decrease in the rate of flu shots since 1997 In 1997, 702 percent of adults with diabetes had received a flu shot in the past year This has since dropped to 601 percent in 2001 It should be noted that influenza vaccine availability was less than ideal in 2000 and 2001 There has been no statistical trend up or down since 1997 in the rate at which adults residing in Idaho with diabetes received pneumonia vaccinations As of 2001, 494 percent of adults
with diabetes in Idaho have had a pneumoccocal vaccination

17

Percent of Adults 18 With Diabetes Who Had a Flu Vaccine, Pneum ococcal Vaccine, Past Year 1997, 1999, 2001

100 80 60 40 20 0 1996

Flu

Pneumonia

1997

1998

1999

2000

2001

In 1997, 702 percent of adults with diabetes had received a flu shot in the past year This has since dropped to 601 percent in 2001 It should be noted that influenza vaccine availability was less than ideal in 2000 and 2001

18

Idaho Diabetes Management Trends Cholesterol Screening
Patients with type 2 diabetes have an increased prevalence of lipid abnormalities that lead to a greater incidence of cardiovascular disease

American Diabetes Association Clinical Practice Recommendations
Testing for lipid disorders cholesterol at least annually and more often if needed is recommended to achieve goals In adults with low-risk lipid values, it is recommended that a repeat lipid assessment is given every two years1

The HP2010 Objective
There are no specific Healthy People 2010 objectives proposed for adults with diabetes and cholesterol screening However, there is a goal to reduce deaths from cardiovascular disease in persons with diabetes3 Proper
management of blood cholesterol levels is one way to reduce mortality in people with diabetes, especially 1 among those who have already had prior cardiovascular events

Year 1997 1998 1999 2000 2001

Receiving Cholesterol Screening 911 NA 843 NA 850

95 Confidence Intervals

Lower
871 NA 788 NA 800

Upper
951 NA 898 NA 900

In Idaho, cholesterol screening has declined since 1997 In 2001, 85 percent reported adequate cholesterol screening consistent with the American Diabetes Association standards of care This is down from 911 percent in 1997

19

Age 18-44 45-64 65

Receiving Adequate Cholesterol Screening, 2001 624 888 917

95 Confidence Intervals

Lower
464 820 864

Upper
784 956 970

100

Percent of Adults 18 With Diabetes Who Have Had Adequate Cholesterol Screening 1997, 1999, 2001

80
Percent of Adults

60

40 20

0 1996 1997 1998 1999 2000 2001

In 2001, people older than 65 were more likely 917 to receive adequate cholesterol screening than those who were younger than 65 years of age5

20

Idaho Diabetes Management Trends High Cholesterol
Patients with Type 2 diabetes have an increased prevalence of lipid abnormalities that leads to a greater incidence of cardiovascular
disease Proper management of blood cholesterol levels may reduce mortality in people with diabetes especially among those who have already had prior cardiovascular events1 Self reported high cholesterol has remained constant since 1997 with a slight increase from 1997 to 1999

American Diabetes Association Clinical Practice Recommendations
It is recommended that adults with diabetes should lower LDL cholesterol to 100 mg/dl as the primary goal of therapy and lower triglycerides to 150 mg/dl and raise HDL cholesterol to 45 mg/dl in men and 55 mg/dl in women1

The HP2010 Objective
There are no specific Healthy People 2010 objectives proposed for adults with diabetes and high cholesterol However, there is a goal to reduce deaths from cardiovascular disease in persons with diabetes3 Proper management of blood cholesterol levels is one way to reduce mortality in people with diabetes, especially among those who have already had prior cardiovascular events1
At Risk For High Cholesterol 454 NA 523 NA 515
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
371 NA 445 NA 440

Upper
536 NA 602 NA 587

Percent of Adults 18 With Diabetes At Risk For High Cholesterol 1997, 1999, 2001
60

Percent of Adults

40

20

0

1996

1997

1998

1999

2000

2001

A person is at risk if they have been screened and have ever been told by a health professional that they have high cholesterol In 2001, 515 percent of adults residing in Idaho with diabetes had been told by a health professional that they had high cholesterol

21

Idaho Diabetes Management Trends Overweight
Being overweight or obese is a major risk factor for the onset of type 2 diabetes A patient with diabetes can decrease insulin resistance and improve glycemic control by losing a moderate amount of weight

American Diabetes Association Clinical Practice Recommendations
In insulin-resistant individuals, reduced energy intake and moderate weight loss improve insulin resistance and glycemia in the short-term1 Therefore, moderate weight loss is recommended

The HP2010 Objective
There are no specific Healthy People 2010 objectives proposed for adults with diabetes that are overweight However, it is recognized that personal behaviors that include a diet high in fat and processed foods as well as total calories, have been associated with a greater number of overweight persons in the United States when compared to a
decade ago, possibly explaining the increasing diagnosis of type 2 diabetes3
Overweight with Diabetes BMI 25 735 745 799 850 820
Percent of Adults 18 Who are Overw eight BMI 251997-2001
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
667 676 734 796 769

Upper
803 814 864 904 872

100 Percent of Adults 80 60 40 20 0

Diabetes Idaho 1997 1998 1999 2000 2001

A person is considered overweight if their Body Mass Index BMI is greater than or equal to 25, or obese with a BMI greater than 30 BMI is calculated by taking weight in kilograms and dividing by height in meters squared The percent of adults residing in Idaho with diabetes who were also overweight has increased significantly since 1997 In 2001, 82 percent of adults with diabetes were estimated to be overweight, an increase from 735 percent in 1997 Overweight prevalence has increased among all adults in Idaho over the same period of time since 1997 Among all adults in Idaho in 2001, 593 percent were overweight5

22

Idaho Diabetes Management Trends Hypertension
Hypertension among persons with diabetes increases the risk for numerous complications including stroke, coronary artery disease, and peripheral disease,
retinopathy, and nephropathy1

American Diabetes Association Clinical Practice Recommendations
Blood pressure should be measured at every routine diabetes visit Patients should have a general goal of maintaining a systolic pressure in mm/Hg of 130 and a diastolic pressure of 80 mm/Hg1

The HP2010 Objective
There are no specific Healthy People 2010 objectives proposed for adults with diabetes and hypertension
At Risk For High Blood Pressure 622 NA 615 NA 643
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
543 NA 544 NA 575

Upper
686 NA 686 NA 711

A person is at risk for hypertension if they have ever been told by a doctor, nurse, or other health professional that they have high blood pressure Prevalence of selfreported hypertension in the form of high blood pressure has remained constant since 1997 with 643 percent of adults with diabetes in 2001 reporting that they had been told by a health professional that they have high blood pressure Among the general population in Idaho, high blood pressure risk increases dramatically with age However, risk for hypertension among persons with diabetes does not significantly increase with age In 2001, 672 percent of those
with diabetes aged 65 and older were at risk compared to 627 percent of those with diabetes between 18 and 64 years of age5

23

Idaho Diabetes Management Trends Cigarette Smoking
Smoking is the leading avoidable cause of mortality in the US, accounting for approximately 434,000 deaths each year Cigarette smoking contributes to one in five deaths in the US, and is a modifiable cause of premature death Smoking compounds the macrovascular and cardiovascular complications that are already highly prevalent among persons with diabetes The American Diabetes Association asserts that smoking cessation is a vital part of diabetes care1

American Diabetes Association Clinical Practice Recommendations
Every smoker should be urged to quit in a clear, strong, and personalized manner that describes the added risks of smoking and diabetes1

The HP2010 Objective
There are no specific Healthy People 2010 objectives proposed for adults with diabetes and cigarette smoking However, when adjusting for age difference the relative severity of smoking prevalence among adults with diabetes becomes more apparent
People with Diabetes who are Current Smokers 122 143 143 167 197
95 Confidence Intervals

Year
1997 1998 1999 2000 2001

Lower
74 86 82 115 141

Upper
170 200 192 220 252

Per cent o f A d ult s 18 W it h D iab et es W ho A r e C ur r ent Smo ker s 19 9 7- 2 0 0 1 40

Diabetics Non-diabetics

30

20

10

0

1997

1998

1999

2000

2001

A current smoker is someone who has smoked at least 100 cigarettes in their lifetime and now smokes some days or everyday Smoking among adults residing in Idaho with diabetes has increased significantly since 1997 Prevalence has increased from 122 percent in 1997 to 197 percent in 2001 During this same period, smoking prevalence among non-diabetics showed little change, decreasing slightly from 203 percent in 1997 to 196 percent in 20015 Like other populations, smoking prevalence among persons with diabetes is associated with being less than 65 years of age In 2001, 264 percent of persons with diabetes age 18-64 were current smokers compared to 101 percent of people age 65 or older When adjusting for age, adults with diabetes smoke at a rate of 29 percent compared to the 20 percent statewide smoking prevalence5

24

National Objectives Idaho Diabetics Who Smoke, Age-Adjusted Data
40

Percent of Adults

30

20

10

24

29 21 12

0 1998
National Baseline 1997 Idaho 2001 Idaho HP2010 Objective

In Idaho, the 2001 age-adjusted estimate of people with diabetes that smoke was 29 percent Diverging sharply away from the national goals of 12 percent5

25

Idaho Diabetes Management Trends Physical Activity
A person is at risk for being sedentary if they have not participated in any physical activities apart from work in the past month

American Diabetes Association Clinical Practice Recommendations
Regular exercise can positively affect glycemic control, risk for cardiovascular disease including both hypertension and cholesterol levels Regular exercise along with proper diet will result in weight loss which contributes to improved diabetes management1

The HP2010 Objective
There are no specific Healthy People 2010 objectives proposed for adults with diabetes and physical activity
Of People With Diabetes With No Leisure Time Physical Activity NA 239 NA 265 310
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
NA 167 NA 205 247

Upper
NA 310 NA 324 373

Percent of Adults 18 With Diabetes With No Leisure Activity, Past Month 1998, 2000-2001 40

30 Percent of Adults

20

10

0

1997

1998

1999

2000

2001

In
2001, 310 percent of adults residing in Idaho with diabetes did not engage in any leisure time physical activity in the past month5 The prevalence of sedentary lifestyles has increased in magnitude since 1998, but the change over time is not considered statistically significant Among adults residing in Idaho with diabetes, 414 percent exercise moderately or vigorously 30 minutes or more a day at least 5 times a week5

26

Activity limitations among Idaho adults with diabetes, 2001
60

Percent of Adults

40

50 20 27

0
Lim ited by Physical/Em otional Im pairm ents No Lim itations

Exercise among people with diabetes often leads to a discussion on the feasibility of people with diabetes and exercise safety Points for consideration are various physical limitations such as sensory loss in feet, glycemic control and proper nutrition Thirtyseven percent of adults with diabetes responded in the BRFSS survey that they were limited in their activities because of physical, mental, or emotional problems Among those who are disabled, 270 percent exercised moderately or vigorously 30 or more minutes a day for at least 5 days a week compared to 502 percent of adults with diabetes not reporting
a disability that limits their activity5

27

Idaho Diabetes Management Trends Quality of Life
Diabetes is a complicated disease that plays a major part in the every day lives of patients When a person with diabetes reports only a fair or poor rating on their own general health, it becomes difficult to expect that individual to follow through with proper self-management of their disease and its numerous complications

American Diabetes Association Clinical Practice Recommendations
It is recommended that persons with diabetes should focus on having a positive influence over blood glucose and overall health by choosing foods wisely, exercising regularly, reducing stress level, and making modest lifestyle changes1

The HP2010 Objective
There are no specific Healthy People 2010 objectives proposed for adults with diabetes and quality of life
Reporting Fair or Poor General Health 407 475 400 481 469
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
329 393 328 409 400

Upper
484 556 472 554 538

There are several categories where a persons quality of life can be assessed Physical health illness and injury and mental health stress levels, depression and problems with
emotions are areas that adults with diabetes can self-assess in determining their own quality of life
Self Reported Health Status
Fair/Poor Good P value

Percent having a household income 25,000 Percent at risk for high blood pressure Percent at risk for high cholesterol Percent current smokers Percent overweight

576 747 598 220 860

347 549 442 177 785

0006 0156 2540 0118 1503

Adults with diabetes who reported only fair or poor general health were more likely to have an annual household income of less than 25,000, be at risk for high blood pressure, be at risk for high cholesterol and currently smoke

28

Idaho Diabetes Management Trends Diabetes Education
Formal education related to self-management of diabetes may help all people with diabetes Education may help overcome the mechanical, physical, and psychological barriers that may complicate proper daily self care

American Diabetes Association Clinical Practice Recommendations
Each individual with diabetes should be involved in a diabetes self-management education program that is an interactive, ongoing process with the educators The education process should include: Assessment of the individuals specific education needs
Identification of the individuals diabetic self-management goals Education and behavioral intervention directed toward helping the individual achieve identified self-management goals Evaluation of the individuals attainment of the identified self-management goals1

The HP2010 Objective
There are no specific Healthy People 2010 objectives proposed for adults with diabetes and diabetes education
Having Diabetes Education NA NA NA 540 643
Percent of Adults 18 With Diabetes Who Have Ever Had Diabetes Managem ent Education 100 2000-2001 Percent of Adults 80 60 40 20 0 2000 2001
95 Confidence Intervals

Year 1997 1998 1999 2000 2001

Lower
NA NA NA 467 578

Upper
NA NA NA 613 711

There was a statistically significant increase between 2000 and 2001 in the percent of adults residing in Idaho with diabetes reporting having had a class to manage their diabetes

29

Ever taken a class on self-managing diabetes

Percent having an annual foot exam Percent checking blood sugar at least once daily Percent having an annual dilated eye exam Percent taking insulin

Yes 684 589 616 329

No 510 464 557 215

P-value 0006 0156 2540 0118

Using 2000 and 2001 data, adults with diabetes who have had a
self-management class, were more likely to have had an annual foot exam, self-monitor blood glucose levels at least daily and to be a current insulin user
National Objectives and Idaho Diabetes Education Data , Age-Adjusted
100 80 60 40 20 0

Percent of Adults

76 60 45

1998 National Baseline

1998 Idaho

2001 Idaho

HP2010 Objective

Using 2001 age adjusted estimates, Idaho has already exceeded the 60 percent national goal for diabetes management courses Data not available in Idaho for 1998

30

References
1

American Diabetes Association: Clinical Practice Recommendations 2002 2002 Diabetes Care vol 25, supplement 1 Tomar, Scott L and Arlene Lester 2000 Dental and Other Health Care Visits Among US Adults with Diabetes, Diabetes Care 23:10, 1505-1510
3 2

US Department of Health and Human Services Healthy People 2010 Rockville, MD: US Department of Health and Human Services, November 2000

Mokdad, Ali H et al 2000 Diabetes Trends in the US: 1990-1998, Diabetes Care 23:9, 1278-1283 Idaho Department of Health and Welfare, Bureau of Health Policy and Vital Statistics Unpublished 2001 Behavioral Risk Factor Surveillance System data Idaho Department of Health and Welfare Boise, ID
Idaho Department of Health and Welfare, Bureau of Health Policy and Vital Statistics Unpublished 2000 Behavioral Risk Factor Surveillance System data Idaho Department of Health and Welfare Boise, ID Idaho Department of Health and Welfare, Bureau of Health Policy and Vital Statistics Unpublished 1999 Behavioral Risk Factor Surveillance System data Idaho Department of Health and Welfare Boise, ID Idaho Department of Health and Welfare, Bureau of Health Policy and Vital Statistics Unpublished 1998 Behavioral Risk Factor Surveillance System data Idaho Department of Health and Welfare Boise, ID Idaho Department of Health and Welfare, Bureau of Health Policy and Vital Statistics Unpublished 1997 Behavioral Risk Factor Surveillance System data Idaho Department of Health and Welfare Boise, ID Campaigne, Barbara N and Kathleen L Wishner 2000 Gender-Specific Health Care in Diabetes Mellitus The Journal of Gender-Specific Medicine, The Journal of GenderSpecific Medicine;3[1]:51-58
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