1. DIABETES DATA PRESENTATION DECEMBER 20, 2012

2. Agenda  Overview  New BRFSS data weighing  Pre-diabetes  Prevalence  Incidence  Eyes and kidneys  Diabetes and smoking  Diabetes Self-Management  Quality of Care  Conclusions

3. Raking (new method) versus Post-stratification (old method) Post-stratification –  landline telephones only  survey data weighted (or normalized to census data) by:  sex and age groups by region BRFSS Data Weighing Changes

4. Raking (new method) versus Post-stratification (old method) Raking –  landline telephones and cell phones (starting in 2011)  survey data weighted (or normalized to census data) by:  Age group by sex  Race  Education level  Marital Status  Home ownership or renter  Sex by race  Age group by race  Telephone source/type (respondent has cell-only, landline-only, or both cell and landline)  Region  Region by age group  Region by sex  Ethnicity BRFSS Data Weighing Changes

5. Why capture cell phones and better adjust the data? In recent years, the old method under-represents important segments of the population

6. Pre-diabetes

7. Adult Alaskans with pre-diabetes by race and AK BRFSS region, 2009-2011- Post Strat

8. Adult Alaskans with pre-diabetes by race and AK BRFSS region, 2009-2011- Raked

10. Percent of Adult Alaskans with Pre-diabetes by Leisure-time exercise and BMI levels 2009-2011

11. Prevalence of Overweight/Obesity from 1991-2011

12. Diabetes Prevalence

13. Diabetes Prevalence, Old Data Method 2000-2011

14. Diabetes Prevalence, Old / New Data Method 2000-2011

16. Diabetes incidence

20. Age at diabetes diagnosis by race, 2009-2011

21. Age at diabetes diagnosis by BMI category, 2009- 2011

22. Vision loss likely related to diabetes increased in US adults from1.4 percent in 1999 through 2002 to 1.7 percent in 2005 through 2008, an increase of 21 percent within less than a decade in the U.S.. Dr. David Friedman from the Wilmer Eye Institute of Johns Hopkins University School of Medicine in Baltimore Fang K, Vitale S, Chou C, Cotch MF, Saaddine J, Friedman D. Prevalence of Nonrefractive Visual Impairment in US Adults and Associated Risk Factors, 1999-2002 and 2005-2008. JAMA. 2012;308(22):2361-2368. doi:10.1001/jama.2012.85685. Eyes and Kidneys

23. Percent of Alaskans with and without Diabetes with Kidney or Eyesight Problems 2011

24. Percent of Alaskans With and Without Diabetes Who Have or Have Had Cataracts 2011

25. Diabetes and tobacco use

26. Percentages of adult Alaskans with diagnosed diabetes, pre-diabetes or no diabetes by smoking status, 2009-2011

27. Health care provider advised stop smoking within previous year by diabetes diagnosis group, 2009-2011

28. Diabetes Self-Management

29. 2000-2011 trend in percentages of Alaskans with diabetes with diabetes education (had ever taken a diabetes self-management class)

30. 2000-2011 trend in percentages of Alaskans with diabetes with diabetes education (had ever taken a diabetes self-management class) Post Strat v. Raked

31. Quality of Care

32. Trends in percentages of Alaskans with diabetes that had received 0, 1, 2 or 3 quality of care activities (dilated eye exam, foot exam and/or at least 2 A1c tests) in the previous year, 2004-2011

35. Percentages of Alaskans with diabetes that had received 0, 1, 2 or 3 quality of care activities (dilated eye exam, foot exam and/or at least 2 A1c tests) in the previous year by race /insurance status, 2009-2011 Health Insurance 012 3

36. Conclusions

37. The new data weighting method, or raking, does change Percentages – but doesn’t change or detract from major findings Alaska Natives have higher rates of prediabetes than whites Southeast Alaska has higher rates of prediabetes than Fairbanks Obese Alaskans have higher rates of prediabetes than overweight and healthy weight Alaskans Diabetes prevalence essentially doubled over last 20 years Age of diabetes diagnoses influenced by race and age, but not obesity Alaskans with diabetes have more kidney problems and cataracts Greater percentage of Alaskans with diabetes are former smokers versus pre-diabetes and no diabetes groups Health insurance seems to be a factor in whether or not diabetes receive recommended quality of care activities.

38. Questions? Gail Stolz 907-269-8034 gail.stolz@alaska.gov 3601 C St., #722 Anchorage, AK 99503 Clint Farr 907-465-8542 Clint.farr@alaska.gov 410 Willoughby Ave, Ste. 110 Juneau, AK 99801