2008 Georgia program and data summary. Diabetes

2008 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 metabolic diseases marked by high blood glucose levels due to defects in insulin production, insulin action, or both. It is also associated with an excess glucose production from the liver. 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. In the United States, about 24 million Americans currently have diabetes.1, 2 With proper disease management, a person with diabetes can still live and fully enjoy a healthy, productive life.
PROGRAM OVERVIEW
The mission of the Georgia Diabetes Prevention and Control Program (DPCP) is to reduce the burden of diabetes in Georgia by preventing disease onset, improving the standards of care for diabetes, and ensuring the well-being of those affected by diabetes. The DPCP has been receiving funding from 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 promote knowledge and public awareness of diabetes and its salient risk factors; to reduce and prevent illness, disabilities, deaths, and costs related to diabetes and its complications; and to improve access to resources and services for people with diabetes. The DPCP strives to reach communities most affected by diabetes and achieve significant improvement in the quality of care and health status of 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, which regulates blood glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. Although disease onset can occur at any age, type 1 diabetes usually strikes children and young adults. 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 (GDM) is a form of glucose intolerance first recognized 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. Soon after childbirth, 5% to 10% of women with GDM continue to have diabetes. Women who have had gestational diabetes have a 40% to 60% chance of developing diabetes, usually type 2 diabetes, in the next 5 to 10 years.1
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
Pre-diabetes, a precursor of 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. This reversible state of abnormal high blood sugar levels can be presented as either impaired fasting glucose, impaired glucose tolerance, or both. About 57 million Americans have pre-diabetes.1, 2
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.

Signs and Symptoms of Diabetes

In 2007, approximately 700,000 (10.1%) adults in Georgia had been diagnosed with diabetes.4
For every two persons who have been diagnosed with diabetes, another has not yet been diagnosed. Thus, approximately 350,000 additional adult Georgians would have undiagnosed diabetes.
Thousands more are at increased risk of getting diabetes because of advancing age, obesity, unhealthy eating habits, and physical inactivity.
Diabetes is a serious disease in Georgia.
In 2006, diabetes was the seventh leading cause of death, killing 1,626 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 2006, the overall age-adjusted diabetes death rate per 100,000 population was 20.2. The rate was 1.3 times higher in men (23.3) than in women (17.8). The rate was also 2.3 times higher among blacks (36.4) than among whites (16.1).
In 2006, more than one-third of diabetes deaths were in persons under the age of 65. The proportion of deaths before age 65 due to diabetes (premature deaths) was highest among black males (53.7%), followed by white males (41.1%), black females (33.0%), and white females (26.6%).5
Georgia counties in the Southwest, South, Central, and Northeast regions had higher age-adjusted diabetes mortality rates than the statewide average from 1999 through 2006.5

Frequent urination Intense thirst Extreme hunger Tiredness Blurred vision Irritability Unexplained weight loss or gain Repeated infections Slow wound healing Dry, itchy skin Tingling and numbness in hands or feet

Deaths per 100,000 population

Age-adjusted diabetes death rates by race and sex, Georgia, 2006

60

Black White

42.4

40

32.2

19.1

20

13.7

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 2006, there were 15,593 hospitalizations for which diabetes was the principal diagnosis, resulting in over $288 million hospital charges and about 78,346 days or 215 years of hospital stay.6
Also in 2006, 19,459 emergency room visits in Georgia were attributable to preventable acute complications of diabetes such as severe hypoglycemia (low blood sugar levels). They required urgent care and cost more than $3.2 million in medical care charges.7
In Georgia, the cost of diabetes due to medical care, lost productivity, and premature death is estimated to be over $5.1 billion per year.8

Symptoms of Hypoglycemia

Hunger Shakiness Sweating

Dizziness Headache Pale skin color

Sleepiness Tiredness Anxiety

Difficulty speaking Clumsy movements Confusion

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 $11,744 per year compared with $5,095 per year for a person of comparable age and sex without diabetes.9
Many complications can be prevented with early detection, proper intervention and comprehensive management.

Percent of diabetes complications that could be reduced or prevented*
Eye disease Kidney disease Amputations 0 -20

Percent Reduction

PREVENTIVE CARE MEASURES
In 2007, adult Georgians with diabetes met only one national target (Healthy People 2010 Objective) for the recommended routine care for persons with diabetes, i.e., the annual A1C testing rate.
Status of recommended routine care for persons with diabetes, Georgia, 20074

-40 -60 -80 -10 0

90%

50%

85%

*Adapted from Diabetes At A Glance, CDC, 2005.

Minimum Recommendation
Annual doctor visit Diabetes education Daily self glucose monitoring Annual Hemoglobin A1c testing Annual dilated eye exam

HP 2010 Objectives
---

Achievement
86%

60%

55%

60%

59%

50%

85%

75%

71%

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.10
Preventive care such as routine eye and foot examinations, regular self-monitoring of blood glucose, and tight glycemic control could reduce these numbers.
Early detection of diabetes symptoms and prompt treatment with tight blood glucose control can decrease the chance of developing complications of diabetes.

Annual foot exam Annual influenza vaccination Pneumococcal vaccination

75% 60% 60%

69% 55% 46%

Risk Factors for Developing Type 2 Diabetes
Physical inactivity Obesity Unhealthy eating habits Sedentary lifestyles Advancing Age Family history of diabetes Past history of gestational diabetes Pre-diabetes Hispanic, Black, Asian, Pacific Islander or
American Indian

Data Sources: 1. Centers for Disease Control and Prevention. National
diabetes fact sheet, 2007. 2. American Diabetes Association. All about diabetes, 2008.
www.diabetes.org. 3. American Diabetes Association. Diabetes 4-1-1: Facts,
figures, and statistics at a glance, Alexandria, 2005. 4. Georgia BRFSS, 2007. 5. Georgia hospital discharges data file, 2006. 6. Georgia emergency room visits data file, 2006. 7. Georgia Division of Public Health. Death records file, 1999-
2006. 8. American Diabetes Association. Diabetes cost calculator.
www.diabetes.org/cost. 9. American Diabetes Association. Economic costs of diabetes
in the U.S. in 2007. Diabetes Care, 31:3, 2008. 10. Centers for Disease Control and Prevention. Diabetes at a
glance, 2005.
Date updated: August 2008 Publication Number: DPH08.206HW

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 members review 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 local vision service providers through several vision projects. The program's activities include diabetes retinopathy screening and early interventions for prevention of blindness and preservation of vision.
Professional Education
In partnership with the Grady Health System, the DPCP offers two workshops and a statewide teleconference especially designed for rural health professionals every year. The workshops cover recent advances in medical treatment, clinical guidelines, patient education, and diabetes management. They also serve as a refresher course for those who are preparing for the certified diabetes educator (CDE) exam. An annual statewide diabetes and cardiovascular conference is also held for area health care providers as part of continuing professional education.
CDE Scholarship Program
Annually, ten scholarships are awarded to eligible candidates as financial assistance for the CDE 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 still make a difference. Pay attention to and control your blood pressure and cholesterol as required. Adopt healthy eating habit and follow the meal plan appropriately. Avoid risk behaviors such as smoking and excess drinking. Don't smoke. If you do smoke, stop or get help now to quit. Stay active. Walk, run, swim, dance, or get involved regularly 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