1. 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 National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation www.cdc.gov/diabetes The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC.

3. Vital statistics Household Surveys Registries Hospitals CDC National Diabetes Surveillance System Telephone Surveys

4. Diabetes Fact Sheet, 2011 www.cdc.gov/diabetes 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

5. 26 million with Diabetes 79 million with Prediabetes

6.  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 Latest Diabetes Prevalence Data www.cdc.gov/diabetes

7. Latest diabetes prevalence data

8. www.cdc.gov/diabetes Age-Adjusted Percentage of U.S. Adults with Diagnosed Diabetes or Obesity Diabetes Prevalence 1994 2000 No Data 9.0% Obesity (BMI ≥30 kg/m 2 ) 19942000 No Data 26.0% 2009

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

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

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

12. 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

13.  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 Diabetes Fact Sheet, 2011 Diabetes rates by race and ethnicity www.cdc.gov/diabetes

14.  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

15. www.cdc.gov/diabetes Non-Hispanic whites Hispanics (overall) Asian Americans Alaska Natives/American Indians (overall) Non-Hispanic blacks

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

17.  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 Diabetes Fact Sheet, 2011 Gestational diabetes http://www.cdc.gov/diabetes/pubs/factsheet11.htm www.cdc.gov/diabetes

18. 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

19. www.cdc.gov/diabetes Prevalence of DM in Youth Source: Pediatrics 2006; based on 6379 cases, from surveillance denominator of 3,499,846 10-19 Years 0-9 Years

20. 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)

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

22. www.cdc.gov/diabetes What about Overweight and Obesity? Type 1 Type 2

23. www.cdc.gov/diabetes Prevalence of Selected Health Behaviors Type 1 Type 2

24. www.cdc.gov/diabetes Minority Youth with Poor Glycemic Control Race/EthnicityType 1 (%)Type 2 (%) Non-Hispanic White12.312.2 African-American35.522.3 Hispanic27.327.4 Asian / Pacific Islander26.036.4 Native American52.243.8

25. Incidence of diagnosed diabetes (1980–2007) and projected incidence (2008–2050) www.cdc.gov/diabetes Source: http: //www.pophealthmetrics.com/content/8/1/29

27. Number of People with Diabetes (20-79 years), 2010 and 2030

28. http://www.cdc.gov/diabetes/pubs/factsheet11.htm Diabetes Fact Sheet, 2011 Health burden  The 7 th 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

29. 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

30. 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

31. Death rates (age adjusted) with hyperglycemic crises as underlying cause per 100,000 with diabetes, U.S., 1980–2005 www.cdc.gov/diabetes Source: www.cdc.gov/diabetes/statistics/mortalitydka/fRateDKADiabTotals.htm

32. Age-Adjusted Percentage of US Adults with Diabetes Reporting Visual Impairment, 1997–2009 www.cdc.gov/diabetes Source: www.cdc.gov/diabetes/statistics/visual/fig2.htm

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

34. Diabetes Fact Sheet, 2011 Economic cost of diabetes http://www.cdc.gov/diabetes/pubs/factsheet11.htm 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) www.cdc.gov/diabetes

35. Prevent diabetes Strategy www.cdc.gov/diabetes Eliminate diabetes-related health disparities Prevent diabetes complications and disabilities

36. 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) Ecological Model

37. The Community – Clinic Partnership Model CommunityClinic Total Population Pre-diabetesDiabetes Complications Informed Population Strong Community Organizations Partnership Zone Information Systems Decision Support Proactive Practice Team Screening for High Risk Diagnosis of Prediabetes and Diabetes Structured Lifestyle Programs Regular Glucose Monitoring Insurers Employers Reimbursement } Healthy Public Policy Supportive Environments Informed, Activated Patient s

38. 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

39. Resources and Media Contacts Division of Diabetes Translation – www.cdc.gov/diabetes www.cdc.gov/diabetes National Diabetes Education Program – www.yourdiabetesinfo.org www.yourdiabetesinfo.org Media Contacts – Email: media@cdc.govmedia@cdc.gov – Phone: 404-639-3286