The Burden of Diabetes in South Dakota

1
The Burden of Diabetes in South Dakota

• (current through 10/09)

2
Executive Summary

• Approx 39,344 of South Dakota adults have been
  diagnosed with diabetes and the prevalence of
  diabetes has more than doubled since 1998
• The prevalence of diagnoses diabetes in Native
  Americans was 11 compared to 6.4 in Whites
• 973 South Dakotans under 18 with diabetes most of
  which are type 1

• South Dakotans aged 65 yrs or older were almost
  twice as likely to have been diagnosed with
  diabetes as persons aged 45 to 64 yrs
• 22.9 of adults aged 20 yrs or older had
  pre-diabetes. Extrapolating this analysis to
  South Dakota shows about 14,250 adult had
  pre-diabetes

3
Executive Summary

• Of South Dakota Women who gave birth between Aug.
  06 and Jan. 07, 1.1 had pre-existing diabetes
  and 7.1 developed gestational diabetes during
  pregnancy
• Overweight or obese places in South Dakotans at
  increased risk for type 2 diabetes and other
  chronic diseases. Among South Dakota adults 38.3
  were overweight and an additional 27.2 were
  obese
• 66.4 of people with diabetes had taken a course
  to learn about diabetes self-care

• 66. of people with diabetes had been told they
  had high blood pressure
• 58.6 of people with diabetes had been told they
  had high cholesterol
• 14.1 of people with diabetes had heart disease.
  Adults with diabetes were five times more likely
  to have suffered a stroke than those without
  diabetes
• South Dakota adults with diabetes are less likely
  that those without diabetes to be current
  smokers. 2.5 of adults with diabetes spit
  tobacco.

4
Executive Summary

• 90.6 of adults with diabetes reported their A1c
  had been checked one or more times in the
  previous yr.
• 73.4 of adults with diabetes stated having their
  feet checked at least once in the previous yr.
• 74.4 of adults with diabetes stated having an
  eye exam in the previous 12 months and 19.4 had
  been told that diabetes had affected their eyes
  or they had retinopathy

• 80.2 of adults aged 65 and older with diabetes
  reported to having a flu shot within the previous
  12 months and 78.4 reported ever receiving a
  pneumococcal shot
• 72.7 of adults aged 18-64 with diabetes reported
  to having a flue shot within the previous 12
  months and 78.4 reported ever receiving a
  pneumococcal shot
• 5.7 of South Dakota adults with diabetes had no
  health insurance

5
Executive Summary

• Per capita annual cost of health care for people
  with diabetes calculated at 11,744 a yr, of
  which 6,649 (57) is attributed to diabetes
• Outpatient training to help people self-manage
  their diabetes prevents hospitalizations
• Preconception care for women with diabetes leads
  to healthier mothers and babies

• There was 246 deaths directly attributed to
  diabetes in 2007 compared to 201 in 2003. Thats
  a 22.4 increase. There have been a total of
  1,174 deaths attributed to diabetes in South
  Dakota residents from 2003-2007
• Native Americans were more likely to die from
  diabetes as the primary cause than whites in
  2007.
• Native Americans have lower age at death than
  whites, 66 yrs versus 80 yrs

6
What is Diabetes?

• Disease which the body does not produce or
  properly use insulin.
• Insulin is a hormone that is needed to convert
  sugar, starches, and other food into energy.
• This disease can be attributed to genetics and
  environmental factors.

7
What is Diabetes?

• Type 1 Diabetes Mellitus
• Bodys failure to produce insulin
• Diagnoses in children and young adults (juvenile
  diabetes)
• Type 2 Diabetes Mellitus
• Insulin resistance body does not properly use
  insulin
• 95 of people with diabetes have type 2
• More common in Native Americans, Latinos, African
  Americans, and Asian Americans/Pacific Islanders
  as well as the aged population

8
What is Diabetes?

• Gestational Diabetes
• Any degree of glucose intolerance with onset or
  first recognition during pregnancy
• Usually disappears after the baby's birth
• Women with gestation Diabetes have a 40-60
  chance of developing type 2 diabetes
• Pre-Diabetes
• Impaired fasting glucose (IFG) or impaired
  glucose tolerance (IGT)
• Persons blood glucose levels are higher than
  normal but not high enough for a diagnosis of
  type 2 diabetes

9
Demographics of South Dakota

• South Dakota is one of the least densely
  populated states with 781,919 people living in is
  75,955 sq. miles
• 60 of South Dakotas total population lives in
  small, rural communities (5,000 or less)
• South Dakota is predominantly non-Hispanic White
  with Native American being the largest minority
• Adults aged 65 and older comprise 14.2 of the
  population, which is higher than the national
  average of 12.4

10
Demographics of South Dakota

• 12.9 of South Dakotans live below 100 of the
  federal poverty level and five of the 10 counties
  in the United States with the lowest per capita
  income are on South Dakota Indian Reservations
• Access to primary care providers, diabetes
  educators and specialists is limited in the state
  with over two-thirds of the state designated by
  the federal government as Medically underserved

11
Demographics of South Dakota

• In July 2008, there are 1,675 physicians
  practicing in South Dakota, over half practicing
  in urban communities (50,000s or more).
• Of the remaining physicians 4.1 practice
  frontier communities (6 or less people per sq.
  mile)
• 40.6 practice in a rural community (more than 6
  persons per sq mile but no population centers of
  50,000 or more)

12
Demographic of South Dakota

• South Dakota has 49 general community hospitals,
  of which 37 are critical access hospitals, and
  three Veterans Administration Hospitals
• 39 federally qualified health center sites, 60
  licensed rural health clinics.
• Four Indian Health Service hospitals, seven
  Service Units, and three Urban Indian Health
  Clinics

13
Demographics of South Dakota

• Prevalence of Diagnosed Diabetes
• According to the CDC nearly 8 of the
  US(24million) has diabetes
• 17.9 million have been diagnosed, another 25
  (5.7 million) people have not been diagnoses
• 2007 Behavioral Risk Factor Surveillance System
  (BRFSS) 6.7 of South Dakotans 18 and older have
  been diagnoses with diabetes about 39,344 adults

14
Demographics of South Dakota

• Prevalence of Diagnosed Diabetes
• Using the National estimate that about 25 of
  people with diabetes are under diagnosed, 13,115
  South Dakotans are likely to not know they have
  diabetes.
• Colorado had the lowest prevalence rate at 5.3
• Tennessee had the highest rate at 11.9
• The national median was 8.0

15
Demographics of Diabetes

• Prevalence of Diagnosed Diabetes
• Diabetes prevalence rates in South Dakota have
  increased gradually since the late 1980s
• Number of people diagnosed with diabetes in South
  Dakota has increased 2.4 points since 1988, the
  prevalence has more than doubled since 1998
• 2007 BRFSS indicated that South Dakotans aged 65
  yrs or older were almost twice as likely to have
  been diagnosed with diabetes as persons aged 45
  to 64 yrs.

16
Demographics of Diabetes

• Prevalence of Diagnosed Diabetes
• Prevalence of diabetes is significantly higher
  among persons of lower income levels
• Racial and ethnic sup-populations in the United
  States suffer from diabetes at disproportionately
  higher rates than the majority population.
• In South Dakota the prevalence of diagnosed
  diabetes among Whites was 6.4 compared to Native
  Americans at 11.0.
• Native American females have higher prevalence of
  diabetes than those of white females 11.4 versus
  6.2

17
Demographics of Diabetes

• Prevalence of Diabetes
• Overweight women of childbearing age increase the
  risk of gestational diabetes mellitus (GDM).
• 7 of all pregnancies are complicated by GDM
• 1.1 pre-existing diabetes 7.1 develop diabetes
  during pregnancy
• CDC calculates 186,300 people younger than 20 yrs
  have diabetes in the US

18
Demographics of Diabetes

• Prevalence of Pre-Diabetes
• According to the CDC 25.9 of US Adults aged 20
  yrs or older had pre-diabetes in 2007
• Approx.149,250 South Dakotans had pre-diabetes in
  2007
• People with pre-diabetes have an increased risk
  of developing type 2 diabetes, heart disease and
  stroke

19
Risk factors for Development for Diabetes

• Type 1 diabetes
• No known modifiable risk factors
• Type 2
• obesity and lack of physical activity

20
Overweight and Obesity Rates

• Prevelance of overweight and obesity has
  increased in South Dakota
• South Dakotans overweight has increased from
  37.8 in 1993 to 38.3 in 2007
• Obese South Dakotans has increased from 15.2 in
  1993 to 27.2 in 2007
• Overweight and obesity is most common in 55-63 yr
  olds
• In 2007 84.8 South Dakotans with diabetes were
  overweight or obese

21
Physical Activity Rates

• To achieve and maintain good health and reduce
  the risk for chronic disease adults are
  recommended to get moderate intensity aerobic
  physical activity
• 30 mins a day, 5 days a wk
• 2007, 32.1 of persons with diabetes engaged in
  moderate activity 49.0 of persons without
  diabetes
• 30 mins a day, 5 days a wk.

22
Quality of life

• People with diabetes can feel overwhelmed from
  their care regimens
• Depression, anxiety and other psychological
  disoders are most common
• Quality of life indictors among South Dakotans
  with diabetes show
• More likely to report poor physical and mental
  health
• Significant limitations to their usual health
• Disability with equipment 3 times higher than
  with out diabetes
• Dissatisfaction with life higher for people with
  diabetes than those without

23
Risk Reduction

• People with diabetes have an increased risk of
  developing a number of life threatening
  complications
• Glucose control
• Improved glycemic control benefits people with
  either type 1 or type 2 diabetes, every
  percentage point A1c drops can reduce the risk of
  microvascular complications
• Intensive insulin therapy has long term
  beneficial effects on the risk of cardiovascular
  in type 1 diabetes
• Blood pressure control
• Reduces the risk of cardiovascular disease by 33
  to 50 and the risk of microvascular
  complications by 33
• Every 10mm Hg reduction in systolic blood
  pressure, the risk for any complication related
  to diabetes is reduced by 12

24
Risk Reduction

• Control of Blood Lipids
• Improved control of LDL cholesterol can reduce
  cardio vascular complications by 20 to 50
• Preventive care practices for eyes, feet and
  kidneys
• Detecting and treating diabetic eye disease can
  reduce development of vision loss by 50 to 60
• Comprehensive foot care can reduce amputation
  rates by 45 to 85
• Lowering blood pressure can reduce the decline of
  the kidneys by 30 to 70
• Angiotensin receptor blockers reduce proteinuria
  by 35

25
Preventive Services

• Diabetes self-management education
• Key step in improving health outcomes and quality
  of life in people with diabetes
• Focuses on self-care behaviors such as eating
  healthy, being active, and monitoring blood sugar
  
• Participation in a course is up from 2000, to
  58.7

26
Preventive Services

• Self-monitored Blood Glucose Testing
• Allows people with diabetes to achieve specific
  glycemic goals,
• Maintenance of normal or near normal blood
  glucose levels has major health benefits
• 67.3 of South Dakotans with diabetes check their
  blood glucose one or more times a day.9 pts
  higher than 2000
• Also increasing by 9 pts were diabetics who never
  check their blood sugar

27
Preventive Services

• Blood Pressure
• High blood pressure contributes to the
  development and progression of diabetes
  complications
• Control of high blood pressure reduces the rate
  of nephropathy, complications of hypertensive
  nephropathy, cerebrovascular and cardiovascular
  disease
• 66.7 with diagnosed diabetes were told by health
  professionals they had high blood pressure

28
Preventive Services

• Blood Lipids
• Type 2 diabetes there is an increased risk for
  obesity and lipid abnormalites that is
  independent of blood glucose control
• 58.6 of people with diabetes had been told they
  had high cholesterol

29
Preventive Services

• Heart Disease and Stroke
• Adult diabetics have heart diseas death rates 2
  to 4 times higher than adults,
• 65 of people with diabetes die from heart diease
• 14.1 of people with diabetes had heart disease
  compared to 3.3 without diabetes
• People with diabetes were 3 times more likely to
  report high blood pressure than those without
  diabetes

30
Preventive Services

• Tobacco use
• Leading cause of preventable death in the United
  States
• Increased risk of complications to blood vessels
• South Dakota adults with diabetes are less likely
  to be current smokers than adults that are non
  diabetic
• 2.5 of adults with diabetes use spit tobacco,
  5.2 of adults without diabetes use spit tobacco

31
Preventive Services

• A1c
• The more glucose in the blood, the more
  glycosylated hemoglobin is present
• Strongpredictive value for diabetes complications
  
• 90.6 of adults with diabetes stated their A1c
  had been checked one or more times in the
  previous yr.

32
Preventive Services

• Feet
• Due to the high glucose on nerves and blood
  vessels diabetes is the leading cause of lower
  limb amputations
• 73.4 of adults with diabetes stated a health
  professional had checked their feet at lease once
  the previous yr

33
Preventative Services

• Eyes
• High blood glucose is caustic to the nerves and
  blood vessels of the eye and can lead to the
  development of diabetic retinopathy
• 74.4 of adults with diabetes stated they had an
  eye exam in the previous 12 months
• 19.4 of adults with diabetes had been told that
  diabetes had affected their eys or their
  retinopathy

34
Preventative Services

• Vaccinations
• Influenza and pneumococaccal vaccines can help
  prevent flu and pneumonia in people with diabetes
  who are at greater risk of hospitalizations
• 80.2 of adults aged 65 and older with diabetes
  reported having a flu shot with in the past 12
  months and 78.4 reported ever receiving
  apneumococcal shot
• 72.7 of adults 18-64 with diabetes reported
  having a flue shot in the past 12 months, 59.4
  reported ever receiving pneumooccal shot

35
Preventative Services

• Oral Health
• People with diabetes get periodontal disease more
  than people without diabetes
• Gum infections made it hard to control blood
  glucose and once an infection starts it is hard
  to heal
• Adults with diabetes are less likely to go to the
  dentist than those without diabetes 60.9 to 70.1

36
Preventative Services

• Insurance Status
• Access to health care is necessary for successful
  treatment of diabetes
• 5.7 of South Dakota adults with diabetes had no
  health insurance in 2007 compared to almost 15
  of adults nationwide.

37
Costs

• Medical expenditures totaled 116 billion and
  were comprised of 27 billion for diabetes care,
  58 for chronic diabetes related complications
  and 31 billion for excess general medical costs
• Indirect costs resulting from increased
  absenteeism, reduced productivity, disease
  related unemployment disability and loss of
  productive capacity due to early mortality
  totaled 58 Billion

38
Mortality

• Diabetes is the leading cause of death
• Diabetes is the 7th cause of death in South
  Dakota
• 1,174 deaths attributed to Diabetes in South
  Dakota from 2003-2007
• Diabetes in not listed as the underlying cause of
  death on the death certificate the number of
  mortality is very underestimated
• Native American are more likely to die from
  diabetes in South Dakota than whites

39
Mortality

• Top 10 South Dakota counties with the highest
  death rates due to diabetes
• Shannon -Corson
• Buffalo -Bennett
• Ziebach -Jackson
• Todd - Mellette
• Dewey -Bon Homme