1. Healthy People 2010 Focus Area 5: Diabetes Progress Review October 20, 2006

2. Diabetes Affects 20.6 million or nearly 10% of the U.S. adult population, with 1.5 million new cases (2005) –Non-Hispanic white: 13.1 million (8.7%) –Non-Hispanic black: 3.2 million (13.3%) 6th leading underlying cause of death (2002) The total cost of diabetes in the U.S. (2002): $132 billion –$92 billion in direct medical costs –$40 billion in indirect costs including disability, work loss, premature mortality Lifestyle changes can prevent or delay the onset of diabetes among high-risk adults Complications can be prevented by control of blood glucose, blood pressure, and blood lipids, and by regular preventive care practices/exams

3. 5-6. Diabetes-related deaths among persons with diabetes 5-12. A1C test at least 2 times a year 5-17. Self blood-glucose monitoring Target met or exceeded Improving 5-10. Lower extremity amputations 5-13. Annual dilated eye examination 5-15. Annual dental examinations Highlighted Objectives Getting worse 5-2. New cases of diabetes 5-3. Prevalence of diabetes Little or no change 5-4. Diagnosed diabetes 5-5. Diabetes related deaths

4. 2000 No DataLess than 4% 4% to 6%Above 6% Diabetes Prevalence Among U.S. Adults NOTE: Data are age-adjusted to the 2000 standard population. SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC. 1995 2004 HP2010 Target: 2.5

5. High school 5 Age-adjusted rate per 1,000 population 2010 Target: 3.8 10 15 Obj. 5-2 I = 95% confidence interval. *Data are for adults aged 18-84 years and are age adjusted to the 2000 standard population. Education estimates exclude persons <25 years of age. †Age-specific estimates are not age adjusted. SOURCE: National Health Interview Survey (NHIS), CDC, NCHS. Education * New Cases of Diabetes, Among Adults 0 Less than HS At least some college 18-4445-6465-74 Age † 1997-992000-02 Total * 75-84 2003-05 20 Decrease desired

6. Native Hawaiian/ Pacific Islander Am. Indian/ Alaska Native I = 95% confidence interval. *Data are statistically unreliable and are suppressed. NOTE: Data are for adults aged 18-84 years and are age-adjusted to the 2000 standard population. The black and white categories exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. For data prior to 1999, respondents reported one or more races and identified one race as best representing their race. For 1999 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), NCHS, CDC. WhiteBlack Asian Hispanic * Total Age-adjusted rate per 1,000 population 1997-992000-02 2003-05 2010 Target: 3.8 * Decrease desired 5 10 15 0 20 Obj. 5-2 New Cases of Diabetes, Among Adults

7. Obj. 5-3 1999 2000 2001 2002 2003 2004 2005 120 100 80 60 40 20 0 Age-adjusted rate per 1,000 population 2010 Target: 25 Prevalence of Diabetes Decrease desired American Indian/ Alaska Native Black not Hispanic Hispanic White not Hispanic Asian Total NOTE: 1999 data for the American Indian/Alaska Native group and all data for the Native Hawaiian/Pacific Islander group are statistically unreliable and are suppressed. Data are age adjusted to the 2000 standard population. Persons of Hispanic origin may be any race. Persons were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), NCHS, CDC.

8. Obj. 5-3 0 25 50 75 100 125 150 175 200 225 Age-adjusted rate per 1,000 population 2010 Target: 25 Total Persons with disabilities Persons w/o disabilities <18 years 18-44 years 45-64 years 65-74 years 75+ years Female Male Less than high school High school At least some college Prevalence of Diabetes, 2005 = 95% confidence interval. NOTE: Data are age adjusted to the 2000 standard population. Age-specific estimates are not age-adjusted. Education estimates exclude persons <25 years of age. SOURCE: National Health Interview Survey (NHIS), CDC, NCHS. 54 per 1,000

9. Black 40 Age-adjusted percent 60 80 Obj. 5-4 Race/ethnicity 0 White Male Female 1988-1994 Total 2001-04 100 Increase desired 2010 Target: 78 Gender Proportion of Diabetes Diagnosed Mexican American NOTE: Data are for adults aged 20 years and over and are age adjusted to the 2000 standard population. The black and white categories exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Prior to 1999, respondents were asked to select one race category; selection of more than one race was not an option. For 1999 and later years, respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. SOURCE: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. 20

10. Obj. 5-5 0 40 80 120 160 Age-adjusted rate per 100,000 population 2010 Target: 46 Total Cuban Asian or Pacific Islander White not Hispanic American Indian Mexican American Puerto Rican Black not Hispanic Female Male Less than high school High school At least some college = 95% confidence interval. NOTE: Data are preliminary. Includes any mention of diabetes as underlying or multiple cause of death. Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option. Education estimates are based on persons aged 25-64 years. SOURCE: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Decrease desired Diabetes-Related Deaths, 2004 76 per 100,000

11. Diabetes Mortality * by Health Service Area: U.S., 2001-2003 NOTE: Includes any mention of diabetes as underlying or multiple cause of death. Data are age-adjusted to the 2000 standard population. SOURCE: National Vital Statistics System — Mortality (NVSS-M), NCHS, CDC. Age-adjusted rate per 100,000 HP2010 Target: 46 Obj. 5-5

12. Obj. 5-6 1999 2000 2001 2002 2003 2004* 11 10 9 8 7 6 5 0 Age-adjusted rate per 1,000 2010 Target: 7.8 Decrease desired Male Female 2004 data are preliminary. NOTE: Data are age adjusted to the 2000 standard population. SOURCE: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Diabetes-Related Deaths Among Persons With Diabetes Total

13. Black 5 Age-adjusted rate per 1,000 10 15 Obj. 5-10 I = 95% confidence interval. *Age adjusted to the 2000 standard population. †Age-specific rates are not age-adjusted. NOTE: Includes any amputation of lower limb. For NHDS data prior to 2000, only one race category was recorded; reporting more than one race was not an option. For NHIS data prior to 1999, respondents reported one or more races and identified one race as best representing their race. Respondents were asked to select one or more races starting in 1999 (NHIS) or 2000 (NHDS), although more than one race selection was not used for 1999 NHIS data in order to be consistent with 1997-1998 data. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Hospital Discharge Survey (NHDS) and National Health Interview Survey (NHIS), CDC, NCHS. Race * 0 White Female Male<6565-74 Age † 1997-99 Total * 75+ 2001-03 20 Decrease desired Lower Extremity Amputations Among Persons With Diabetes 2010 Target: 2.9 Gender *

14. Obj. 5-12 0 50 60 70 80 90 100 Age-adjusted percent 2010 Target: 65 Total Hispanic Black not Hispanic White not Hispanic American Indian Asian Female Male Less than high school High school At least some college Increase desired A1C Test at Least Two Times a Year Among Adults With Diabetes, 2004 = 95% confidence interval. NOTE: Data for the Native Hawaiian or Pacific Islander group are statistically unreliable and are suppressed. Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races and identify one race as best representing their race. Education estimates exclude persons <25 years of age. SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC.

15. I = 95% confidence interval. * Excludes persons <25 years old. NOTE: Data are age adjusted to the 2000 standard population. Data for the American Indian or Alaska Native, Asian, and Native Hawaiian or Pacific Islander groups are statistically unreliable and are suppressed. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Prior to 1999, respondents were asked to select one or more races and identify one race as best representing their race. For 1999 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), CDC, NCHS. High school 30 Age-adjusted percent 2010 Target: 76 40 50 Obj. 5-13 Education Level * 0 Less than High School At least some college Total 60 Increase desired Annual Dilated Eye Exams Among Adults With Diabetes 1998 2003 70 80 BlackHispanic White Race/ethnicity

16. 45-64 30 Age-adjusted percent 2010 Target: 71 40 50 Obj. 5-15 Age † 0 Total * 60 Increase desired 1997 2005 70 80 BlackHispanic White Race/ethnicity * Annual Dental Exams Among Persons With Diabetes *Age adjusted to the 2000 standard population. †Age-specific estimates are not age adjusted. NOTE: Data are for persons aged 2 years and over. Data for the American Indian or Alaska Native, Asian, and Native Hawaiian or Pacific Islander groups are statistically unreliable and are suppressed. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Prior to 1999, respondents were asked to select one or more races and identify one race as best representing their race. For 1999 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), CDC, NCHS. 18-4465-74 75-84

17. I = 95% confidence interval. † At least once daily. *Data are statistically unreliable and are suppressed. NOTE: Data for the Native Hawaiian or Pacific Islander group are statistically unreliable and are suppressed. Data are age adjusted to the 2000 standard population. The black and white categories exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Prior to 2001, respondents were asked to select one race category; selection of more than one race was not an option. For 2001 and later years, respondents were asked to select one or more races and identify one race as best representing their race. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC. American Indian/ Alaska Native AsianBlack White Hispanic Total Age-adjusted percent 19982002 2004 2010 Target: 61 30 50 60 80 0 40 70 Self Blood-Glucose Monitoring † Among Adults With Diabetes 20 10 Obj. 5-17 * Increase desired

18. 5-1. Diabetes Education 5-2. New cases of diabetes 5-3. Prevalence of diabetes 5-4. Diagnosis of diabetes 5-5. Diabetes deaths 5-6. Diabetes related deaths among persons with diabetes 5-7. Cardiovascular disease deaths among persons with diabetes 5-8. Gestational diabetes* 5-9. Foot ulcers* 5-10. Lower extremity amputations 5-11. Annual urinary microalbumin measurement 5-12. A1C test at least 2 times a year 5-13. Annual dilated eye examinations 5-14. Annual foot examinations 5-15. Annual dental examinations 5-16. Aspirin therapy 5-17. Self blood-glucose monitoring Dropped at the Midcourse * ImprovingGetting worseLittle or no changeBaseline onlyTarget met Status of Diabetes Objectives

19. Summary Incidence and prevalence of diabetes are increasing –Rates higher in older, lower educated, and some racial/ethnic minorities Diabetes-related and cardiovascular disease deaths among those with diabetes have met targets, but large disparities persist by race/ethnicity and gender Lower extremity amputations are decreasing Rates of preventive services to avoid complications have improved and/or met the target, with high rates in some racial/ethnic minority groups For some objectives, smaller racial/ethnic groups lack reliable data

20. Progress review data and slides are available on the web at: http://www.cdc.gov/nchs/hphome.htm