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					               The Diabetes Problem
         What the new statistics tell us and
           implications for the future

                                   Ann Albright, PhD, RD
                  Director, Division of Diabetes Translation
                 Centers for Disease Control and Prevention


The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC.


                           National Center for Chronic Disease Prevention and Health Promotion
                           Division of Diabetes Translation            www.cdc.gov/diabetes
              Hospitals                   Household
                                            Surveys


                           CDC
             National Diabetes Surveillance System




Vital statistics


Registries                          Telephone
                                       Surveys
 Diabetes Fact Sheet, 2011




 Citation: Centers for Disease Control and Prevention, National diabetes fact sheet: national estimates and general
 information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human
 Services, Centers for Disease Control and Prevention, 2011.

 http://www.cdc.gov/diabetes/pubs/factsheet11.htm
www.cdc.gov/diabetes
26 million
with Diabetes

79 million
with Prediabetes
Latest Diabetes Prevalence Data
 25.8 million people in the U.S. have diabetes
     • 17.8 million are diagnosed
     • 8.0 million are undiagnosed
     • 11.3% of those >20 years old
     • 26.9% of those >65 years old

 79 million people in the U.S. have
   prediabetes


Source: Diabetes Fact Sheet, 2011
http://www.cdc.gov/diabetes/pubs/factsheet11.htm
www.cdc.gov/diabetes
                Latest diabetes prevalence data




www.cdc.gov/diabetes
 Age-Adjusted Percentage of U.S. Adults with
 Diagnosed Diabetes or Obesity
                            Diabetes Prevalence
           1994                            2000                       2009




      No Data      <4.5%      4.5-5.9%        6.0-7.4%     7.5-8.9%            >9.0%


                           Obesity (BMI ≥30 kg/m2)
            1994                            2000                        2009




      No Data     <14.0%      14.0-17.9%      18.0-21.9%   22.0-25.9%        >26.0%

www.cdc.gov/diabetes
County-Level Estimates of Diagnosed Diabetes
Among US Adults Aged ≥20 Years: 2004–2008




www.cdc.gov/diabetes
    County-Level Estimates of Obesity
Among US Adults Aged ≥20 Years: 2004–2008




www.cdc.gov/diabetes
County-Level Est. of Leisure-Time Physical Inactivity
  Among US Adults Aged ≥20 Years: 2004–2008




www.cdc.gov/diabetes
 County-Level Diabetes, Obesity, Leisure-
 Time Physical Inactivity: Key Trend

• Counties with high levels of all three are primarily
  concentrated in the South and Appalachia

• Counties with low levels of all three are primarily
  concentrated in the West and Northeast




www.cdc.gov/diabetes
 Diabetes Fact Sheet, 2011
 Diabetes rates by race and ethnicity
 7.1% of non-Hispanic whites >20 years old have
  diabetes

 Rate is 18% higher for Asian Americans >20 years old

 Rate is 66% higher for Hispanics >20 years old overall
     • Similar to non-Hispanic whites for Cubans and Central and
       South Americans
     • 87% higher for Mexican Americans
     • 94% higher for Puerto Ricans

www.cdc.gov/diabetes
 Diabetes Fact Sheet, 2011
 Diabetes rates by race and ethnicity
 Rate is 77% higher for non-Hispanic blacks >20
  years old
 16.1% of the adult population served by Indian
  Health Service has diagnosed diabetes
     • 5.5% among Alaska Native adults
     • 33.5% among American Indian adults in
       southern Arizona


www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Diabetes rates by race and ethnicity
           Non-Hispanic whites   Non-Hispanic blacks
           Asian Americans       Alaska Natives/American Indians (overall)
           Hispanics (overall)




www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Diabetes rates by race and ethnicity
   Non-Hispanic whites      Non-Hispanic blacks
   Asian Americans          Alaska Natives/American Indians (overall)
   Hispanics (overall)      Specific AN/AI groups
   Specific Hispanic groups




www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Gestational diabetes
 2%–10% of pregnant women will
  develop gestational diabetes
    • Likely rate will be higher when using new
      diagnostic criteria

 Women are much more likely to get
  type 2 diabetes later if they have
  gestational diabetes
    • 5%–10% immediately after pregnancy
    • 35%–60% within 10–20 years

http://www.cdc.gov/diabetes/pubs/factsheet11.htm
www.cdc.gov/diabetes
       Burden of Diabetes in Youth
 Applied to US Census data, we estimate that
  In 2001: 154,000 US youth had physician-dx diabetes
  15,000 youth are diagnosed annually with T1 diabetes
  3600 youth are diagnosed annually with T2 diabetes




www.cdc.gov/diabetes
                Prevalence of DM in Youth

                   0-9 Years                                         10-19 Years




Source: Pediatrics 2006; based on 6379 cases, from surveillance denominator of 3,499,846

www.cdc.gov/diabetes
Annual Incidence per 100,000 people
by Race/Ethnicity & Clinical DM Type




    Source: SEARCH for Diabetes in Youth Study (2002-2005 data)

www.cdc.gov/diabetes
                Beyond Type:
    Characteristics of Youth with Diabetes
             Type 1           Type 2




www.cdc.gov/diabetes
 What about Overweight and Obesity?

            Type 1     Type 2




www.cdc.gov/diabetes
   Prevalence of Selected Health Behaviors

            Type 1             Type 2




www.cdc.gov/diabetes
 Minority Youth with Poor Glycemic Control


       Race/Ethnicity         Type 1 (%)   Type 2 (%)
    Non-Hispanic White           12.3         12.2
      African-American           35.5         22.3
           Hispanic              27.3         27.4
   Asian / Pacific Islander      26.0         36.4
      Native American            52.2         43.8




www.cdc.gov/diabetes
Incidence of diagnosed diabetes (1980–2007)
and projected incidence (2008–2050)




Source: http: //www.pophealthmetrics.com/content/8/1/29


www.cdc.gov/diabetes
Number of People with Diabetes (20-79 years),
 2010 and 2030
Diabetes Fact Sheet, 2011
Health burden
  The 7th leading cause of death in the U.S.
     • Underlying cause on 71,382 death certificates
     • Contributing cause on 231,404 death certificates
  The leading cause of kidney disease
  The leading cause of nontraumatic lower-limb
   amputations
  The leading cause of new cases of blindness
  Significant contributor to heart disease and stroke

www.cdc.gov/diabetes    http://www.cdc.gov/diabetes/pubs/factsheet11.htm
Diabetes Fact Sheet, 2011
Health burden
 Heart disease and stroke
     • 2 to 4 times more likely in people with diabetes
 Hypertension
     • 67% of adults with diabetes have hypertension
 Eye Problems
     • 28.5% of people with diabetes >40 years old had
       diabetic retinopathy
 Kidney disease
     • Over 200,000 people with diabetes-related ESRD on
       chronic dialysis or had a transplant (2008)
www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Health burden
 Nervous system disease
     • 60% to 70% of people with diabetes >40 years old have
       mild to severe nervous system damage

 Other examples of possible health complications
     • Dental disease
     • Pregnancy complications
     • Greater susceptibility to diseases such as influenza and
       pneumonia
     • Depression


www.cdc.gov/diabetes
Death rates (age adjusted) with hyperglycemic crises as
underlying cause per 100,000 with diabetes, U.S., 1980–2005




Source: www.cdc.gov/diabetes/statistics/mortalitydka/fRateDKADiabTotals.htm

www.cdc.gov/diabetes
 Age-Adjusted Percentage of US Adults with Diabetes
 Reporting Visual Impairment, 1997–2009




Source: www.cdc.gov/diabetes/statistics/visual/fig2.htm

www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Treatment of diabetes: U.S., 2007–2009




www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Economic cost of diabetes
 Medical expenses for people with diabetes are more
 than two times higher than for people without
 diabetes
 Indirect costs               $ 58 billion
 Direct costs                $116 billion
 Total                       $174 billion
                                (2007 figures)




http://www.cdc.gov/diabetes/pubs/factsheet11.htm
www.cdc.gov/diabetes
                       Strategy

Prevent diabetes


Prevent diabetes complications and disabilities


Eliminate diabetes-related health disparities




www.cdc.gov/diabetes
Ecological
Model                 Community and policy


                           System, group,
                               culture

                               Family,
                           friends, small
                               group



                             Individual




  The health of individuals is inseparable from the health of communities
                             (Healthy People 2010)
The Community – Clinic Partnership Model
                      Community                    Clinic

               Insurers         Partnership Zone
                       }
             Employers          Reimbursement         Proactive Practice
                                                            Team
Informed Population    Screening for       Diagnosis of
                        High Risk           Prediabetes   Decision Support
 Strong Community                          and Diabetes
   Organizations
                       Structured Lifestyle                 Information
                            Programs                        Systems
  Healthy Public
  Policy                               Regular              Informed,
           Supportive                  Glucose              Activated
           Environments               Monitoring             Patients




Total Population           Pre-diabetes       Diabetes       Complications
                 Summary
• More people have diabetes and more are
  developing it
• Future projections underscore prevention is
  critical
• Diabetes management remains a priority
• Eliminating disparities is key
• There are effective diabetes prevention and
  management interventions that must be
  scaled-up and sustained
  Resources and Media Contacts
• Division of Diabetes Translation
  – www.cdc.gov/diabetes
• National Diabetes Education Program
  – www.yourdiabetesinfo.org


• Media Contacts
  – Email: media@cdc.gov
  – Phone: 404-639-3286

				
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