1. The Burden of Diabetes in South Carolina 2009

2. Chapter 1. Demographics and Access to Health Care

3. Figure 1.1. South Carolina Estimated Population Distribution as of July 1, 2007 Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

4. Figure 1.2. Trends in Race/Ethnic Populations 1980-2007 (other than white and African American) Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

5. Figure 1.3. Age Distribution of Estimated Population as of July 1, 2008 Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

6. Oconee Pickens Anderson Abbeville Greenville Spartanburg Cherokee Laurens Union Edgefield Greenwood McCormick Newberry Saluda Aiken Chesterfield Fairfield Kershaw Lancaster Lexington Chester York DarlingtonDillon Florence Georgetown Horry Marion Marlboro Williamsburg Beaufort Berkeley Charleston Colleton Dorchester Hampton Jasper Allendale Bamberg Barnwell Orangeburg CalhounClarendon Lee RichlandSumter Figure 1.4. Urban, Rural and Very Rural Counties Based on Size of Largest Town Urban Rural Very Rural Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

7. Figure 1.5. South Carolina Primary Care Health Professional Shortage Assessment by Type, as of June 2007 Generated by DHEC Chronic Disease Epidemiology & Evaluation Data Source: http://www.scdhec.gov/health/opc/docs/HPSA_primarycare.pdf February 2009

8. Fig 1.6. Physicians Employed in South Carolina, 2005 1-39 40-99 100-600 County Total 1200+ Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

9. Fig. 1.7. Number of Certified Diabetes Educators by County, 2008 < 8.9% 8.9-10.3% > 10.3% State Rate: 9.6% Diabetes Prevalence Data Source: AADE, Generated by Chronic Disease Epidemiology and Evaluation February 2009

10. Fig 1.8. Pharmacists Employed in South Carolina, 2005 Data Source: ORS, Generated by DHEC’s Chronic Disease Epidemiology & Evaluation February 2009

11. Figure 1.9. South Carolina DPCP* Diabetes Coalitions Beaufort Clarendon Spartanburg Cherokee Union Greenville Pickens Oconee Anderson Abbeville Greenwood McCormick Laurens Saluda York Chester Fairfield Newberry Edgefield Lancaster Kershaw Richland ● Lexington Aiken Calhoun Sumter Lee Barnwell Bamberg Allendale Hampton Horry Colleton Charleston Dorchester Berkeley Georgetown Jasper Williamsburg Chesterfield Marlboro Dillon Darlington Florence Marion Orangeburg ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● Data Source: Diabetes Prevention and Control Program February 2009 Active Non-Active * Coalitions are considered “Non-Active” if no activity has been reported in one year.

12. Chapter 2. Risk Factors

13. Chapter 2.a Risk Factors in the General Population

14. Figure 2.1. Prevalence of Overweight or Obese among Adults by Race-Sex, SC, 1986-2007 Percent Data Source: SC BRFSS, Generated by DHEC’s Chronic Disease Epidemiology & Evaluation February 2009

15. Figure 2.2. Prevalence of Overweight or Obese among Adults, 2007

16. Figure 2.3. Prevalence of Physical Inactivity among Adults by Race-Sex, SC, 2000-2006 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

17. Figure 2.4. Prevalence of Physical Inactivity among Adults, SC BRFSS, 2007 10-19 20-24 25-30 31-36 % Physical Inactivity Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation February 2009

18. Figure 2.5. Prevalence of Consuming Fruits and Vegetables Less Than 5-A-Day among Adults by Race-Sex, SC, 1990-2007 % Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

19. 15.0-15.9 16.0-17.9 18.0-19.9 20.0-25.0 Percent Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009 Figure 2.6. Prevalence of Consuming Fruits and Vegetables Less than 5-A-Day among Adults, SC BRFSS, 2007

20. Figure 2.7. Prevalence of Current Cigarette Smoking among Adults with Diabetes by Race-Sex, SC, 2007 % Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

21. Oconee Pickens Anderson Abbeville Greenville Spartanburg Cherokee Laurens Union Edgefield Greenwood McCormic k Newberry Saluda Aiken Chesterfield Fairfield Kershaw Lancaster Lexington Chester York DarlingtonDillon Florence Georgetown Horry Marion Marlboro Williamsburg Beaufort Berkeley Charleston Colleton Dorchester Hampton Jasper Allendale Bamberg Barnwell Orangeburg Calhoun Clarendon Lee Richland Sumter 16.0-19.9 20.0-21.9 22.0-24.9 25.0-30.0 Percent of Smokers Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009 Figure 2.8. Prevalence of Smoking among Adults, SC BRFSS, 2007

22. Figure 2.9. Age-Specific Prevalence of Major Behavioral Risk Factors among Adults, SC BRFSS, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

23. Chapter 2.b Diabetes Management and Control

24. Figure 2.10. Prevalence of Taking Insulin or Diabetes Pills Among People with Diabetes by Race and Sex, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

25. Figure 2.11. Prevalence of Taking Insulin and Diabetes Pills by Age among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

26. Figure 2.12. Prevalence of Having Blood Glucose Checked among People with Diabetes by Race, Sex, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

27. Figure 2.13. Prevalence of Having HbA1c Checked among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

28. Figure 2.14. Prevalence of Having Eyes Examined among People with Diabetes by Race-Sex, SC BRFSS, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

29. Figure 2.15. Prevalence of Eyes Being Affected by Diabetes among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

30. Figure 2.16. Prevalence of Having Taken a Course for Managing Diabetes among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

31. Figure 2.17. Prevalence of Receiving Flu Shot in Past 12 Months and Ever Received Pneumonia Vaccine among People with Diabetes, SC, 2007. Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

32. Figure 2.18. Prevalence of Having Feet Checked by a Health Professional in the Last Year among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

33. Figure 2.19. Prevalence of Self-Checking Feet for Sores or Irritations among People with Diabetes, By Race, Sex, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

34. Figure 2.20. Prevalence of Seeing a Health Professional for Diabetes in Past Year, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

35. Chapter 3. Diabetes Morbidity

36. Figure 3.1. Prevalence of Self-reported Diabetes by Race-Sex, SC 1988-2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

37. Figure 3.2. Prevalence of Self-Reported Diabetes among Adults by Age, SC 2002-2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

38. Figure 3.3. Age of Diagnosis of Diabetes among People with Diabetes, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

39. Figure 3.4. Prevalence of Diabetes among Adults, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

40. Figure 3.5. Proportion of Hospitalizations with Diabetes of All Hospitalizations by Race-Age 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

41. Figure 3.6. Total Number of Hospitalizations for Diabetes as the Primary Diagnosis, SC, 1987-2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

42. Figure 3.7. Number of Hospital Discharges with Diabetes as the Primary Diagnosis by Age, SC, 1997, 2001 and 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

43. Figure 3.8. Rate of Hospitalizations with Diabetes as Primary or Secondary Diagnosis, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

44. Figure 3.9. Age-Standardized Rate of Hospitalizations for Diabetes, (Primary Diagnosis), SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

45. Figure 3.10. Total Hospital Charges (Million Current & Constant $) for Diabetes as the Primary Diagnosis, SC, 1987-2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

46. Figure 3.8. Rate of Hospitalizations with Diabetes as Primary or Secondary Diagnosis, 2006 (Rate per 100,000) Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

47. Figure 3.11. Total Charges for Hospitalization among Patients with Diabetes by Race-Sex, 1987, 1997, 2001, and 2006 Male Female White Black Primary Diagnosis Secondary Diagnosis $1,000,000 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

48. Figure 3.12. Average Hospital Charge for Diabetes as Primary Diagnosis by Age, SC, 1991-2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

49. Figure 3.13. Sources of Payment for Hospitalization among Patients with Diabetes as the Primary Diagnosis, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

50. Figure 3.14. Total Length of Hospital Stay for Patients with Diabetes as the Primary Diagnosis, 1996-2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

51. Figure 3.15. Prevalence of CVD and Stroke by Diabetes Status, SC, BRFSS 2006 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

52. Figure 3.16. Number of Hospitalizations for Major Diseases & Procedures by Diabetes Status, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

53. Figure 3.17. Distribution of Complications among Inpatients with Diabetes as Primary Diagnosis, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

54. Figure 3.18. Age-Adjusted Hospitalization of Diabetic Ketoacidosis by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

55. Figure 3.19. Age-specific Hospitalization Rates of Diabetic Ketoacidosis by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

56. Figure 3.20. Age-Adjusted Hospitalization Rate of Diabetic Renal Failure by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

57. Figure 3.21. Age-Specific Hospitalization Rate of Diabetic Renal Failure by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

58. Figure 3.22. Dialysis Prevalence with Diabetes as Major Diagnosis, SC, 1997-2006. Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

59. Figure 3.23. Age-Adjusted Hospitalization Rate of Diabetic Dialysis by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

60. Figure 3.24. Age-Adjusted Hospitalization Rate of Diabetic Lower Extremity Amputation by Race-Sex, SC, 1997-2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

61. Figure 3.25. Age-Specific Hospitalization Rates for Diabetic Foot Amputation by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

62. Figure 3.26. Percent of Live Births by Mother's Diabetes Status, SC, 2004 -2006 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation February 2009

63. Figure 3.27. Age-Adjusted Hospitalization Rate of Gestational Diabetes, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

64. Figure 3.28. Age-Adjusted Rate of ER Visits for Diabetes as the Primary Diagnosis by Race-Sex, SC, 1997-2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

65. Figure 3.29. Rates of ER Visits with Diabetes as the Primary Diagnosis by Age, SC, 1997, 1999, 2001 and 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

66. Figure 3.30. Age-Standardized Rate of ER Visits for Diabetes, (Primary Diagnosis), SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

67. Figure 3.31. Number of ER Visits with Selected Diabetic Complications by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

68. Figure 3.32. Total Charges for ER Visits with Diabetes as the Primary Diagnosis by Age, SC, 1997-2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

69. Chapter 4. Diabetes Mortality

70. Figure 4.1. Age Adjusted Mortality Rate for Diabetes as the Underlying Cause of Death, SC, 1996-2006 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation February 2009

71. Figure 4.2. Age Adjusted Mortality Rates for Diabetes as the Underlying Causes of Death by Race, Sex, SC, 1990-2006 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation May 2009

72. Figure 4.3. Age-Specific Crude Mortality Rate for Diabetes as the Underlying Cause of Death, SC, 2006 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation May 2009

73. 8.0-19.9 20.0-29.9 30.0-39.9 40.0-64.0 County 3 Year Mortality Rate per 100,0000 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation February 2009 Figure 4.4. Age-Adjusted Mortality of Diabetes (Underlying Cause of Death), SC, 2003-2006

74. Figure 4.5. Racial Rate Ratio of Diabetes as the Underlying Cause of Death, SC, 2004-2006

75. Figure 4.6. Total Number of Years of Potential Life Lost for Diabetes as Underlying Cause of Death by Race-Sex, SC, 1997-2006 Before the age of 75 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation May 2009