2007 Georgia Program and Data Summary: DIABETES Diabetes is a common, serious, and costly disease, but it is controllable. In many cases, it is also preventable. WHAT IS DIABETES? Diabetes is a group of diseases marked by high blood glucose levels due to defects in insulin production, insulin action, or both. Diabetes can cause serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.1 In the United States, about 21 million Americans currently have diabetes.2 PROGRAM OVERVIEW The mission of the Georgia Diabetes Prevention and Control Program (DPCP) is to reduce the burden of diabetes in Georgia and to improve the well-being of those affected by diabetes. The DPCP has been funded by the Centers for Disease Control and Prevention through a cooperative agreement since 1977. The program conducts a broad range of public health activities designed to reduce and prevent deaths, disabilities, and costs related to diabetes and its complications; to promote knowledge and awareness of diabetes; and to improve access to resources and services for people with diabetes. While implementing these strategies, the DPCP strives to reach communities most affected by diabetes and improve the quality of care for Georgians with diabetes. Types of Diabetes Type 1 diabetes develops when the body's immune system destroys pancreatic beta cellsthe only cells in the body that make the hormone insulin that regulates blood glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for 5% to 10% of all diagnosed cases of diabetes. Type 2 diabetes usually begins as insulin resistance, a disorder in which the body cells cannot use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Type 2 diabetes is the most common form, accounting for 90% to 95% of all diagnosed cases of diabetes. It is also strongly associated with obesity and physical inactivity and is typically related to increasing age.3 Gestational diabetes is a form of glucose intolerance that occurs in some women during pregnancy. Gestational diabetes occurs in 4% to 7% of pregnant women and is one of the most common medical complications of pregnancy.3 It can affect both the mother and the baby. Preeclampsia, spontaneous abortions, congenital malformations, and stillbirths are among the serious complications of diabetes during pregnancy. Women who have had gestational diabetes have a 20% to 50% chance of developing diabetes in the next 5 to 10 years. 1 Pre-diabetes is a condition in which a person's blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. About 54 million Americans have pre-diabetes - either impaired fasting glucose, impaired glucose tolerance, or both.2 Other types of diabetes result from specific genetic conditions, surgery, drugs, malnutrition, infections, and other illnesses, accounting for 1% to 5% of all diagnosed cases.1 Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 ga-diabetes@dhr.state.ga.us http://health.state.ga.us Diabetes is a common disease in Georgia. In 2006, approximately 608,000 (9.1%) adults in Georgia reported that they had been diagnosed with diabetes. For every two persons who have been diagnosed with diabetes, another has not yet been diagnosed. Thus, approximately 304,000 additional adult Georgians have undiagnosed diabetes. Thousands more are at increased risk of getting diabetes because of aging, obesity, unhealthy eating habits, and physical inactivity. Diabetes is a serious disease in Georgia. In 2005, diabetes was the seventh leading cause of death, killing 1,717 Georgians, equivalent to almost 5 deaths every day. For every death with diabetes as the primary cause, there were two other deaths in which diabetes was a contributing cause. In 2005, the age-adjusted diabetes death rate was 1.2 times higher in men (25.5) than in women (20.7). The rate was also 2.5 times higher among Blacks (44.0) than among Whites (17.5). Signs and Symptoms of Diabetes Frequent urination Intense thirst Extreme hunger Tiredness Blurred vision Irritability Unexplained weight loss or gain Repeated infections Delayed wound healing Dry, itchy skin Tingling and numbness in hands or feet Georgia counties in the southwest, central, and northeast regions had higher age-adjusted diabetes mortality rates than the statewide average from 1999 through 2005.4 Age-adjusted mortality rates (AAMR) for diabetes by county Georgia, 1999-2005 About one-third of diabetes deaths are in persons under the age of 65. In 2005, the proportion of premature deaths due to diabetes was highest among black males (51.0%), followed by white males (43.8%), black females (32.6%), and white females (23.7%). Age-adjusted diabetes death rates by race and sex, Georgia, 2005 AAMR per 100,000 population 31 79 21 30 8 20 Statistically unreliable Statewide average AAMR 23 deaths per 100,000 population Deaths per 100,000 population 60 Black White 45.8 42.1 40 21.1 20 14.7 0 Male Female Diabetes is a costly disease in Georgia. Diabetes can contribute to blindness, kidney failure, amputations, heart disease, stroke, high blood pressure, nerve damage, impotence, skin disorders, periodontal disease, pregnancy complications, disability, and premature death. In 2005, there were 15,349 hospitalizations for which diabetes was the principal diagnosis, resulting in over $250 million hospital charges and about 77,400 days or 212 years of hospital stay. In Georgia, the cost of diabetes due to medical care, lost productivity, and premature death is estimated to be over $4 billion per year. Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 ga-diabetes@dhr.state.ga.us http://health.state.ga.us Although there is no cure yet, diabetes is preventable and controllable. Remember, diabetes is controllable. Take charge of your diabetes. For Life. The health care cost for a person with diabetes is approximately $13,200 per year compared with $2,600 per year for a person of comparable age without diabetes.5 Many complications can be prevented with early detection, proper intervention and comprehensive management. PREVENTIVE CARE MEASURES In 2006, adult Georgians with diabetes met only two national targets (Healthy People 2010 Objectives) for recommended routine care for persons with diabetes. Status of recommended routine care for persons with diabetes, Georgia, 2006 Minimum Recommendation Annual doctor visit Diabetes education Daily self glucose monitoring Annual Hemoglobin A1c testing Annual dilated eye exam Annual foot exam Annual influenza vaccination Pneumococcal vaccination HP 2010 Objectives --- Achievement 89% 60% 56% 60% 62% 50% 84% 75% 65% 75% 73% 60% 52% 60% 44% Risk Factors for Developing Type 2 Diabetes Physical inactivity Obesity Advancing Age Family history of diabetes Hispanic, Black, Asian, Pacific Islander or American Indian Past history of gestational diabetes Unhealthy eating habits Sedentary lifestyles Pre-diabetes Percent of Diabetes Complications that Could be Reduced or Prevented* Percent 100 90 80 60 40 20 0 Eye disease 50 Kidney disease 85 Amputations *Adapted from Diabetes At A Glance, CDC, 2005. Each year, according to the Centers for Disease Control and Prevention, 12,000 to 24,000 persons with diabetes in the United States become blind, while more than 42,800 suffer kidney failure and about 82,000 have leg, foot, or toe amputations. Preventive care such as routine eye and foot examinations, regular self-monitoring of blood glucose, and tight glycemic control could reduce these numbers.6 Early detection of diabetes symptoms and prompt treatment with tight blood glucose control can decrease the chance of developing complications of diabetes. Data Sources: 1. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2005. 2. American Diabetes Association. All About Diabetes, 2007. www.diabetes.org. 3. American Diabetes Association. Diabetes 4-1-1: Facts, Figures, and Statistics at a Glance, Alexandria, 2005. 4. Georgia Division of Public Health, Office of Health Information & Policy. OASIS, 2007. 5. American Diabetes Association. Economic costs of diabetes in the U.S. in 2002. Diabetes Care. 26:927. 6. Centers for Disease Control and Prevention. Diabetes At A Glance, 2005. Date updated: August 2007 Publication number: DPH07/094HW Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 ga-diabetes@dhr.state.ga.us http://health.state.ga.us Selected Program Activities The Georgia Diabetes Coalition The Georgia Diabetes Coalition (GDC) consists of area health care providers, local public health professionals, Georgians with diabetes, and community leaders. The GDC provides advice and recommendations to the Georgia Diabetes Prevention and Control Program (DPCP) regarding statewide program services, initiatives, and activities. The coalition meets regularly to discuss and evaluate initiatives related to diabetes and make recommendations for program interventions. Diabetes Today Program This community-based program addresses diabetes related problems from a public health perspective. The program aims to empower both individuals and groups of people for building linkages in their communities to promote and support diabetes prevention and control efforts. Drive for Sight Program Funded by voluntary donations from the driver's license renewal process, this program provides financial support to several vision projects. The program's activities include diabetes retinopathy screening and early interventions for prevention of blindness and vision conservation. Professional Education In partnership with the Grady Health System, the DPCP offers two workshops and a statewide teleconference for rural health professionals every year. The workshops cover recent advances in treatment, patient education, and diabetes management. They also serve as a review course for the certified diabetes educator (CDE) exam. An annual statewide diabetes and cardiovascular conference is also held for area health care professionals. CDE Scholarship Annually, ten scholarships are awarded to eligible candidates to pay for the exam fees or tuitions. Community Outreach Collaborating with local professional organizations, the DPCP supports community outreach events such as Diabetes Expo, Victory Over Diabetes, and Diabetes University in metro Atlanta. If you have diabetes, Know Your ABCs. Keep them at desirable levels as indicated below. A Hemoglobin A1C: Less than 7% B Blood Pressure: Under 130/80 mmHg C Cholesterol: LDL (bad cholesterol): Below 100 mg/dL HDL (good cholesterol): Men Over 40 mg/dL; Women Over 50 mg/dL Triglycerides: Below 150 mg/dL Get CHECKED. Get your blood sugar checked daily or as recommended by your doctor. Get your A1C checked at least twice a year. Get your feet checked daily and at all doctor visits. Get your eyes dilated and checked at least once a year. Get your urine checked for the protein albumin as needed. A Few More Tips... Take medications as prescribed to control your blood sugar. Receive a flu shot every year and a pneumonia shot as needed. Maintain a healthy body weight. Lose excess weight if needed. Even reducing a few pounds (5 to 7% of your body weight) can make a difference. Stay active. Walk, run, swim, or get involved in any kind of physical activity you enjoy. Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 ga-diabetes@dhr.state.ga.us http://health.state.ga.us