1. Diabetes Disparities & Its Effects on Minority Populations Appathurai Balamurugan, MD, MPH Section Chief, Chronic Disease Epidemiology, ADHHS Assistant Professor, Department of Epidemiology, UAMS College of Public Health

2. Objectives To discuss the Burden To elucidate the Disparities & Its Effects on Minority Populations To evaluate the risk Factors To offer some possible solutions

3. Source: International Diabetes Federation (2003) The Diabetes Atlas. Crude prevalence (%) 9.0 and above 6.8 to 8.9 4.9 to 6.7 2.6 to 4.8 2.5 and less No data available Prevalence of Diabetes, 2003, The World

4. Prevalence of Diabetes Among Adults in the United States, 2004 Source: CDC

5. Diabetes Prevalence in Arkansas, 2005 Source: 2005 BRFSS

6. Estimated Number of Adult Arkansans with Diabetes, 2005 Source: 2005 BRFSS & CDC

7. Diabetes Prevalence by Race in Arkansas, 2005 Percentage Source: 2005 BRFSS

8. Estimated Prevalence of Diabetes in People Aged 18 Years or Older, By Race and Age Group, Arkansas, 2006 Source: 2006 BRFSS

9. Estimated Prevalence of Diabetes in People Aged 18 Years or Older, by Race and Gender Group, Arkansas, 2006 Source: 2006 BRFSS

10. Age-adjusted Diabetes Mortality Rate per 100,000 Arkansans by Race, 2000-2005 Source: CDC wonder

11. Age-adjusted Diabetes Mortality Rate per 100,000 Arkansans by Race and Gender, 2002-2004 Source: CDC wonder

12. New cases of diabetes in US, by Race and Gender (age-adjusted incidence) Percentage Source: Lipton et al. Am J Epidemiol, 1993.

13. Diabetes & Heart Disease Frequency of MI was 3 times higher among African Americans with diabetes compared to whites. 64% of African Americans with Diabetes were diagnosed with Hypertension compared to 54% in Whites.

14. Diabetic Kidney Disease Source: ESRD Network, 2005

15. Diabetic Eye Disease Race and SexRelative Risk compared with Diabetic white males White males 1.00 White females1.25 Nonwhite males1.27 Nonwhite females3.86 Age-adjusted Relative Risk of Blindness due to Diabetes Source: Kahn et al, Am J Oph 1974

16. Diabetic foot disease

17. Risk Factors Non-modifiable: Genetic (Thrifty genotype), race, age Modifiable: Unhealthy eating habits, physical inactivity, tobacco use, access to care

18. Risk Factors in Adult Arkansans by Race, 2005 Source: 2005 BRFSS Percentage

19. Percent of Arkansans by Race and Ethnic Origin without Health Insurance, 2005 Source: 2005 BRFSS

20. Percentage of Adults with diabetes that obtained preventive care services by race Source: 2005 BRFSS

21. Possible solutions Primary Prevention – Increase awareness, risk factor reduction Secondary Prevention - Promote access to quality diabetes care Tertiary Prevention - Use of preventive care services

22. Socio-ecological Model Public Policy Community Organizational Interpersonal Individual