Healthy People 2010Focus Area 5

Diabetes Progress Review

December 18, 2002

Diabetes Model

Related Deaths Per Year: 200,000 +

Reduced Life Expectancy: 5-15 years

Medicare: 25% of Costs

Estimated Annual Costs: ~ $100 billion (direct and indirect)

Societal CostsAcute Complications

Amputations

Birth Defects

Blindness/Eye Disease

Dental Disease

Flu & Pneumonia-Related Deaths

Heart Disease

High Blood Pressure

Kidney Disease

Pregnancy Complications

Nervous System Damage

Stroke

Increase risk for:

Self-management of Diabetes

Provider Services

General Population

Pre-diabetes (16 million persons)

Diagnosed DiabetesUndiagnosed Diabetes

Prevention ofDiabetes-Related Complications

Prevention ofDiabetes

Physical ActivityNutrition

Healthy WeightAccess

0

25

50

75

100

125

150

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/Pacific Islander

2010Target

Ag

e-a

dju

ste

d r

ate

per

1,0

00 s

tan

dar

d p

op

ula

tio

n

Total

Persons with diabetes in the U.S.: 17 million (11.1 million diagnosed + 5.9 million undiagnosed)

I 95% confidence interval.

5-3. Diagnosed Diabetes Prevalence, 2000

Source: National Health Interview Survey (NHIS), CDC, NCHS.

0

2

4

6

8

10

12

14

16

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Rat

e p

er 1

,000

po

pu

lati

on

0-44 Years

Total

45-64 Years

65-74 Years75+ Years

Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in 1997.Source: National Health Interview Survey (NHIS), CDC, NCHS. www.cdc.gov/diabetes/statistics/prev/national/Table8.htm.

5-3. Prevalence of Diagnosed Diabetes by Age: United States, 1980-1999

20

40

60

160

140

120

100

80

0

2

4

6

8

10

12

14

16

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Rate

per

1,0

00 p

opul

atio

n

0-44 years

Total

45-64 years

65-74 years

75+ years

5-3. Prevalence of Diagnosed Diabetes by Age:United States, 1980-1999

20

40

60

160

140

120

100

80

+ 28 +3

+ 23 +5

+ 10 +4

+ 26 +7

+ 24 +12

Percent change

(1980-1996) (1997-1999)

Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in 1997.Source: National Health Interview Survey (NHIS), CDC, NCHS. www.cdc.gov/diabetes/statistics/prev/national/Table8.htm.

0

1

2

3

4

5

6

7

8

5-3. Prevalence of Diagnosed Diabetes by Race/Ethnicity and Gender

Black females

Black males

White femalesWhite males

80

70

60

50

40

30

20

10

Age

-adj

uste

d ra

te p

er 1

,000

sta

ndar

d po

pula

tion

Hispanic males

Hispanic females

Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in 1997.Source: National Health Interview Survey (NHIS), CDC, NCHS. www.cdc.gov/diabetes/statistics/prev/national/fig4data.htm.

0

1

2

3

4

5

6

7

8

5-3. Prevalence of Diagnosed Diabetes by Race/Ethnicity and Gender

Black females

Black males

White females White males

Hispanic males

80

70

60

50

40

30

20

10

Black female +32 +4

Hispanic male +4

Black male +50 -1

Hispanic female +2

White male +16 +11

White female +10 +2

Percent Change

1980-96 1997-99

Age

-adj

uste

d ra

te p

er 1

,000

sta

ndar

d po

pula

tion

Hispanic females

Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in 1997.Source: National Health Interview Survey (NHIS), CDC, NCHS. www.cdc.gov/diabetes/statistics/prev/national/fig4data.htm.

5-3. Prevalence of Diagnosed Diabetes, Adults 18 years and over, by State, United States

Note: 1994: 3-Year Average; 2000: 2-Year Average.Source: Behavioral Risk Factor Surveillance Survey (BRFSS), CDC, NCCDPHP.www.cdc.gov/diabetes/statistics/prev/state/fig61994and2000.htm

1994 2000

Age-adjusted percent

<4% 4-4.9% 5-5.9% 6+%

*Note: Diagnosed incidence derived from algorithm using age at interview and age at diagnosis.Source: National Health Interview Survey (NHIS), CDC, NCHS.

0123456789

1011121314151617

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/Pacific Islander

2010Target

Age-adjusted rate per 1,000 standard population

Total

5-2. Diagnosed Diabetes Incidence*: Adults Age 18-84, by Race/Ethnicity, 1998-2000

**

**Unreliable estimate, relative standard error >30%. I 95% confidence interval.

Source: National Vital Statistics System-Mortality, (NVSS-M), CDC, NCHS.

0

25

50

75

100

125

150

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/PacificIslander

2010Target

5-5. Diabetes-Related Death Rates*: 2000

Age-adjusted death rate per 100,000 standard population

Total

*Any mention of diabetes on death certificate as underlying or contributing cause.

Source: National Vital Statistics System (NVSS-M), CDC, NCHS.

0

50

100

150

200

250

300

350

White, not Hispanic

Black, not Hispanic

Hispanic

2010Target

5-7. Cardiovascular Disease Death Rates Among Persons with Diabetes, 2000

Age-adjusted death rate per 100,000 standard population

Total Females Males

Note: Data for American Indian/Alaska Native and Asian/Pacific Islander are not shown due to small cell sizes.

All Cause Deaths in Persons with Diabetes

820 per 100,000

.

0

200

400

600

800

1000

1999 2025

Projected Increase in Total Heart Disease Deaths Related to Increased Diabetes Prevalence

Heart Disease Deaths (thousands)

21%

29%724

883

Proportion of heart disease deaths due to diabetes

Source: Unpublished estimates from the National Heart, Lung, and Blood Institute, October 18, 2002.

Source: Unpublished estimates from the National Heart, Lung, and Blood Institute, October 18, 2002.

842883

724

0

200

400

600

800

1000

1999 2025 2025

Projected Increase in Total Heart Disease Deaths, U.S. Population

Heart Disease Deaths (thousands)

Diabetes MellitusPrevalenceIncreases

Diabetes MellitusPrevalenceUnchanged

0

2

4

6

8

10

12

14

16

2010Target

5-10. Lower Extremity Amputations Among Persons with Diabetes, 1998-2000

Age-adjusted rate per 1,000 standard population

Total Black White Female Male < 65 65-74 75+

Age (not adjusted)I 95% confidence interval.

Note: Data for American Indians/Alaska Natives, Asian/Pacific Islanders and Hispanics are not shown due to small cell sizes.

Source: National Hospital Discharge Survey (NHDS) and National Health Interview Survey (NHIS), CDC, NCHS.

0

10

20

30

40

50

60

70

80

90

100

A1C test foot dental eye education high bloodpressurecontrol

Sources: CDC: Behavioral Risk Factor Surveillance Survey (BRFSS), NCCDPHP; National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), NCHS. * Target-to-be-determined. **Exceeds total population target (50%).

Diabetes-Related Complications: Provider Services For Adults with Diabetes

Annual Influenza vaccination

Pneumococcal Vaccination (ever)

Age 18-64

Most recent level 2010 Target

*

Age-adjusted percent

Age 65+

Direction desired

Age 18-64 Age 65+Annual exam2 x year

2001 1999 1988-94 20002000

61% 61%60%55%

65%

75% 75% 75%

90%

60% 60%

90%

51%

36%

68%

23%

60%**60%

Source: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

0

20

40

60

80

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/Pacific Islander

5-12. A1C Tests: Persons with Diabetes, 2001*

Age-adjusted percent receiving two or more tests in the past year**

**Target-to-be-determined.

Total

*41 reporting States and D.C. I 95% confidence interval.

5-13. Annual Dilated Eye Examinations: Persons with Diabetes, by Race/Ethnicity

0

10

20

30

40

50

60

70

80

White, notHispanic

Black, notHispanic

2010 Target

Total

Hispanic

1998 1999Age-adjusted percent

Note: Data for American Indians/Alaska Natives are for IHS Service Areas. Asian/Pacific Islander data are not shown due to small cell sizes.

I 95% confidence interval.

American Indian/Alaska Native

Sources: National Health Interview Survey (NHIS), CDC, NCHS, and Indian Health Service.

Source: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

0

25

50

75

100

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/Pacific Islander

2010Target

Age-adjusted percent

5-14. Annual Foot Examinations: Persons with Diabetes, 2001*

Total

*41 reporting States and D.C. I 95% confidence interval.

0

10

20

30

40

50

60

70

80

Provider Services Utilization: Persons with Diabetes by Education Level

Age-adjusted percent

A1C Test2 x year

EyeDental Diabetes Education

(1999)

FootAnnual Exam

(2001)

Less than high school At least some college

(1999)(2000)(2001) Sources: CDC: Behavioral Risk Factor Surveillance Survey (BRFSS), NCCDPHP; National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), NCHS.

I 95% confidence interval

Sources: CDC: Behavioral Risk Factor Surveillance System (BRFSS), NCCDPHP; National Health and Nutrition Examination Survey (NHANES), and National Health Interview Survey (NHIS), NCHS.

0

10

20

30

40

50

60

Moderate physical activity Healthy weight Aspirin use

Diabetes-Related Complications:Self-Management of Diabetes: Adults with

Diabetes

Self monitoring blood glucose

2010 Target Most recent level Direction desired

60%

30%

60%

50%57%

20%

12%

21%

2001 2000 1988-1994

Age-adjusted percent

1999-2000

Source: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

0

20

40

60

80

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/Pacific Islander

2010Target

Age-adjusted percent

5-17. Self-Blood Glucose Monitoring: Persons with Diabetes , 2001*

Total

*41 reporting States and D.C. I 95% confidence interval.

Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

0

5

10

15

20

25

30

35

Black, not Hispanic

MalesFemalesMexicanAmerican

White, notHispanic

2010Target

5-16. Aspirin Therapy*: Persons with Diabetes, Age 40 years and Over, 1988-94

Age-adjusted percent

Total

*Took aspirin at least 15 times in past month. I 95% confidence interval.

Sources: National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

0

10

20

30

40

50

60

70

80

Moderate physical activity

Age-adjusted percent

High blood pressureObesity

Persons with diabetes Persons without diabetes

Healthy weight

2000 1988-94

Selected Risk Factors

I 95% confidence interval.

1999-2000

0

10

20

30

40

50

60

70

80

Moderate physical activity

Age-adjusted percent

High blood pressureObesity

Persons with diabetes Persons without diabetes

Healthy weight

2000 1988-94

Selected Risk Factors

I 95% confidence interval.

1999-2000

Sources: National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. *Body Mass Index > 30

19-2. Obesity*: Adults Age 20 and Over,by Race/Ethnicity

0

5

10

15

20

25

30

35

40

45

White, notHispanic

Black, notHispanic

2010 Target

Total

Mexican American

1988-94 1999-2000Age-adjusted percent

I 95% confidence interval.

0

5

10

15

20

25

30

35

40

45

1980 1985 1990 1995 1999

0

5

10

15

20

25

30

35

40

45

Obesity and Diagnosed Diabetes Prevalence

Age-adjusted percent

Note: Diagnosed diabetes data are 3-year averages. Obesity is Body Mass Index > 30. Obesity data for 1976-80 are for ages 20-74.Sources: National Health Interview Survey, National Health and Nutrition Examination Survey, CDC, NCHS.

Age-adjusted rate per 1,000 standard population

Obesity Diagnosed Diabetes

Diagnosed Diabetes

Obesity

(1976-80)

(1988-94)

(1999-2000)

20001995199019851980

(All ages)

(20+ years)

Developmental Objectives

5-08. Decrease the proportion of pregnant women with gestational diabetes

(future source, National Vital Statistics System-Natality)

5-09. Reduce frequency of foots ulcers in persons with diabetes

(future source, National Health and Nutrition Examination Survey)

5-11. Increase the proportion of persons with diabetes who obtain an annual urinary albumin measurement

(proposed source, Behavioral Risk Factor Surveillance System)

0

10

20

30

40

1980 2000 2025 2050

Projected Diagnosed Diabetes in the U.S.

Projected number of people with diagnosed diabetes (millions)

Population growth assumption*HighMiddleLow

*All population projections assume increasing diabetes prevalence rates.

Reported

Projected

1975

Sources: U.S. Census Bureau, National Health Interview Survey (NHIS), CDC, NCHS. Boyle et al. Diabetes Care, Vol. 24, No.11, November 2001.

2010 Target

Progress review data and slidescan be found on the web at:

http://www.cdc.gov/nchs/hphome.htm

Data Notes• Objective numbers in the “Provider Services For Adults with Diabetes” slide are as follows: A1C test

(5-12), foot (5-14), dental (5-15), eye (5-13), education (5-1), high blood pressure control (12-10), and influenza /pneumococcal vaccination (14-29).

• Objective numbers in the “Self-management of Diabetes” slide are as follows: self-monitoring blood glucose (5-17), aspirin use (5-16), healthy weight (19-1), and moderate physical activity (22-2).

• Objective numbers in the “Selected Risk Factors” slide are listed above except for high blood pressure (12-9).

• Data are age adjusted to the 2000 standard population.

• The American Indian/Alaska Native and Asian Pacific Islander categories include persons of Hispanic and non-Hispanic origin.

• Persons of Hispanic origin may be of any race.