2012 Georgia diabetes burden report: an overview [2012]

ere, y,
2012 Georgia Diabetes Burden Report: An Overview

Background
Diabetes and its complications are serious medical conditions disproportionately affecting vulnerable population groups including: aging (elderly) adults, medically underserved, pregnant women and persons of various ethnic backgrounds.1,2 In Georgia, diabetes impacts both sexes and crosses cultural, sociodemographic and geographic boundaries.

Diabetes Affects Georgians
Diabetes Diabetes mellitus (also known as Diabetes) is a medical condition characterized by the presence of high blood glucose (blood sugar) levels in the body.1 It is one of the most common chronic diseases in Georgia and the United States.1 Prediabetes (also known as Borderline Diabetes) Prediabetes is a medical condition whereby individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes.1 Adults with prediabetes have an increased risk of developing Type 2 diabetes, heart disease, and stroke.1
In Georgia, diabetes impacts both sexes and crosses cultural and geographic boundaries.
3

Risk Factors for Diabetes

Genetic and lifestyle factors contribute to the development of diabetes. Risk factors for Type 2 Diabetes include1:

being 45 years of age or older

family history of diabetes

history of gestational diabetes mellitus (GDM)

history of pre-diabetes

overweight or obese status

physical inactivity

hypertension (blood pressure value of 140/90 or greater)

high or abnormal cholesterol (triglyceride level 250 or higher or high density lipoprotein (HDL) value of 35 or lower)

certain race/ethnic groups:

Black, Non-Hispanic Native Hawaiian or other Pacific Islander, Non-Hispanic

Hispanic

American Indian/Alaska Native, Non-Hispanic

Asian, Non-Hispanic

4

Diabetes Prevalence in Georgia

Table 1. Prevalence of Diabetes among Georgia Adults, 2010
Diabetes Condition

Prevalence

Estimated Population

Diagnosed Diabetes

9.7%

703,289

Undiagnosed Diabetes*

6.5%

461,293

Prediabetes (Borderline Diabetes)

1.1%

79,720

Gestational Diabetes~

3.0%

3,782

*Estimate is derived from the Centers for Disease Control and Prevention's Diagnosed and Undiagnosed Diabetes prevalence for adults 20 years of age and older only. For more information, see http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf ~Estimate derived from 2010 Birth Certificate Data
Data Source: Behavioral Risk Factor Surveillance System (2010)
In 2010, using the Behavioral Risk Factor Surveillance System survey, the prevalence of diabetes among Georgia adults was 9.7% (703,289 adults), which is similar to the national adult diabetes prevalence of 9.2%.3

Between 2000 and 2010, diabetes prevalence among Georgia adults increased significantly by 43 percent from 6.8% (395,808 adults) in 2000 to 9.7% (712,203 adults) in 2010(Figure 1).3

Figure 1. Prevalence of Diabetes among Georgia Adults by Year, 2000-2010 Data Source: Behavioral Risk Factor Surveillance System (2000-2010)
5

Map 1. Prevalence of Diabetes among Georgia Adults* by Health District, 2008-2010
Prevalence
Less than 8.7% 8.8% - 11.1% More than 11.1%
*Adults 20 years of age or older Data Source: Behavioral Risk Factor Surveillance System, 2008-201 0

Georgia Highlights

Diabetes prevalence is not dispersed equally throughout Georgia.
West Central (Columbus) and South (Valdosta) Public Health Districts have a significantly greater diabetes prevalence than the state at 12.9% (34,844 adults) and 13.4% (24,778 adults), respectively.

Table 2. Prevalence of Diabetes among Georgia Adults by Public Health District, 2008-2010

Health District
1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Jonesboro) 3-4 East Metro (Lawrenceville) 3-5 DeKalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens)
Georgia

Prevalence % (95% CI)
9.4 (7.8, 11.3) 8.6 (6.8, 10.8) 8.5 (6.8, 10.6) 9.0 (7.0, 11.4) 8.1 (6.0, 11.0) 10.1 (7.9, 12.8) 7.5 (5.7, 9.7) 8.1 (6.3, 10.2) 12.2 (9.4, 15.6) 10.9 (8.5, 13.8) 10.2 (8.1, 12.7) 8.7 (6.8, 10.9) 12.9 (10.3, 16.0) 13.4 (11.0, 16.3) 12.6 (10.1, 15.5) 9.4 (7.3, 12.0) 10.7 (8.6, 13.2) 8.9 (7.1, 11.0) 9.7 (9.2, 10.3)

Estimated Population*
43,405 27,105 38,540 54,900 60,761 19,220 52,299 44,778 70,752 12,346 39,473 29,103 34,844 24,778 33,956 38,491 28,540 31,212 703,289

Data Source: Behavioral Risk Factor Surveillance System (2008-2010)

*Estimated population will not sum to equal the overall estimated population .

7

In addition, diabetes prevalence by county can be accessed at: http://apps.nccd.cdc.gov/DDT_STRS2/CountyPrevalenceData.aspx?mode=DBT.

Nearly two-thirds of Georgia counties are estimated to have a diabetes prevalence among adults greater than 11.1%.

Map 2. Prevalence of Diabetes among Georgia Adults by County, 2008-2010

Prevalence

Less than 8.7% 8.8% - 11.1% More than 11.1%

*Adults 20 years of age or older Data Source: Centers for Disease Control and Prevention, Division of Diabetes Translation (http://apps.nccd.cdc.gov/DDTSTRS/ default.aspx last accessed October 9, 2012)

Diabetes affects both male and female Georgians of all ages and race/ ethnicities.

8

Diabetes is a Serious Medical Condition in Georgia

Brief Overview: Demographic Characteristics among Adults with Diagnosed Diabetes in Georgia

Table 3. Prevalence of Diabetes among Georgia Adults by Sex and Race/Ethnicity, 2008-2010

Sex Male
Female Race/Ethnicity
White, Non-Hispanic Black, Non-Hispanic
Hispanic Other*, Non-Hispanic Race/Ethnicity-Sex White, Non-Hispanic, Male Black, Non-Hispanic, Male White, Non-Hispanic, Female Black, Non-Hispanic, Female

Prevalence % (95% CI)
9.8 (8.9, 10.8) 9.6 (9.0, 10.2)
8.4 (7.9, 9.0) 12.8 (11.4, 14.3) 9.0 (6.5, 12.4) 9.8 (6.9, 13.8)
8.8 (7.9, 9.7) 12.4 (10.0, 15.2)
8.1 (7.4, 8.8) 13.2 (11.7, 14.8)

Estimated Population
346,589 356,700
382,469 236,570 34,151 41,532
194,079 102,429 188,390 134,142

Georgia (overall)

9.7 (9.2, 10.3)

*Other race includes Asian, Native Hawaiian/Pacific Islander, American Indian/Native Alaskan and multiracial
Data Source: Behavioral Risk Factor Surveillance System (2008-2010)

703,289

9

Gender The prevalence of diabetes was similar among adult Georgia men and women at 9.8% (346,589 adults) and 9.6% (356,700 adults), respectively (Table 3).
Race/Ethnicity The prevalence of diabetes among Georgia adults is significantly greater in Black, Non-Hispanics (12.8%; 236,570 adults) as compared to White, Non-Hispanics (8.4%; 382,469 adults). More specifically, as compared to their White, Non-Hispanic counterparts, diabetes prevalence is significantly greater
Figure 2. Prevalence of Diabetes among Georgia among Black, Non-Hispanic women and Black, Non-Hispanic men at 13.2% and 12.4%, respectively (Figure 2). Adults by Race/Ethnicity-Sex, 2008-2010
Figure 2. Prevalence of Diabetes among Georgia Adults by Race/Ethnicity-Sex, 2008-2010

14

13.2

12.4

12

Prevalence (%)

10

8.8

8.1

8

6

4

2

0

Black, Non- White, Non-

Black, Non-

Hispanic

Hispanic

Hispanic

Male Race/Ethnicity-Sex

Data Source: Behavioral Risk Factor Surveillance System (2008-2010) Data Source: Behavioral Risk Factor Surveillance System (2008-2010)

White, NonHispanic
Female

10

Demographic Status

Prevalence % (95% CI)

Estimated Population

Table 4. Prevalence of Diabetes among Georgia Adults by Sociodemographic Status, 2008-2010

Age

18-24

2.4 (0.7, 7.4)

13,378

25-34

3.0 (2.0, 4.3)

45,705

35-44

5.0 (4.0, 6.1)

84,577

45-54

9.9 (8.8, 11.2)

136,925

55-64

18.5 (16.9, 20.1)

184,818

65+

23.0 (21.6, 24.5)

233,552

Employment Status

Employed

6.3 (5.6, 6.9)

279,622

Out of Work

5.9 (4.4, 7.9)

31,640

Unable to Work

28.9 (25.6, 32.4)

116,919

Education Level

Not High School Graduate

15.8 (14.0, 17.7)

117,479

High School Graduate

11.4 (10.2, 12.7)

225,024

Some College

9.8 (8.8, 11.0)

181,797

College Graduate

6.6 (5.8, 7.6)

175,418

Annual Household Income

Less than $15,000

17.5 (15.3, 20.0)

96,345

$15,000 - $24,999

14.0 (12.3, 16.0)

152,242

$25,000 $34,999

11.6 (9.8, 13.7)

78,660

$35,000 - $49,999

9.7 (8.3, 11.3)

86,269

$50,000 - $74,999

8.5 (7.2, 10.0)

86,796

$75,000 or more

5.4 (4.6, 6.4)

119,007

Insurance Status

Any Health Care Coverage

7.6 (6.9, 8.3)

375,192

No Health Care Coverage

7.4 (6.1, 8.9)

88,584

Disability Status

Disabled

20.5 (19.0, 22.0)

290,781

Not Disabled

7.0 (6.4, 7.6)

403,474

Data Source: Behavioral Risk Factor Surveillance System (2008-2010)

11

Age
Figure 3. Prevalence of Diabetes among Georgia Diabetes prevalence increases with age (Figure 3). Georgians 65 years of age and older had a significantly greater prevalence of diabetes than any other age group at 23% (233,552 adults), which was 9.6 times the prevalence of diabetes among 18 to 24 Adults by Age Group, 2008-2010 year olds (2.4%; 13,378 adults).

Figure 3. Prevalence of Diabetes among Georgia Adults by Age Group, 2008-2010

25

23.0

20

18.5

Prevalence (%)

15

9.9 10

5.0

5 2.4

3.0

0 18-24

25-34

35-44

45-54

Age Group (Years)

Data Source: Behavioral Risk Factor Surveillance System (2008-2010) Data Source: Behavioral Risk Factor Surveillance System (2008-2010)
12

55-64

65+

Level of Education
Figure 4. Prevalence of Diabetes among Georgia Diabetes affects Georgians of all levels of education (Figure 4). The prevalence of diabetes was significantly higher among Georgia adults who did not graduate from high school at 15.8% as compared to adults of higher education levels. The prevalence of diabetes Adults by Level of Education, 2008-2010 among these adults who did not graduate from high school was 2.4 times higher than the diabetes prevalence among college graduates (6.6%).
Figure 4. Prevalence of Diabetes among Georgia Adults by Level of Education, 2008-2010
20

Prevalence (%)

15.8 15

11.4

10

9.8

6.6

5

0 Not High School Graduate

High School Some College Graduate
Level of Education

College Graduate

Data Source: Behavioral Risk Factor Surveillance System (2008-2010) Data Source: Behavioral Risk Factor Surveillance System (2008-2010)
13

Household Income
Figure 5. Prevalence of Diabetes among Georgia Diabetes prevalence increases as household income decreases (Figure 5). With a diabetes prevalence of 17.5% (95,345 adults), households with an income of less than $15,000 had a significantly greater diabetes prevalence than households in income groups
Adults by Annual Household Income, 2008-2010 of $25,000 or more. As compared to the diabetes prevalence in households with incomes of $75,000 or more (5.4%; 119,007 adults), the diabetes prevalence was 3.4 times higher in households with incomes of less than $15,000. Figure 5. Prevalence of Diabetes among Georgia Adults by Annual Household Income, 2008-2010
20 17.5

Prevalence (%)

15

14

11.6

10

9.7 8.5

5.4 5

0 Less than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 more
Annual Household Income
Data Source: Behavioral Risk Factor Surveillance System (2008-2010) Data Source: Behavioral Risk Factor Surveillance System (2008-2010)
14

Figure 6. Percentage of Adults with Diabetes by HealthInsurancestatus 19% (88,584 adults) of diabetics under the age of 65 do not have any form of health care coverage (Figure 6). Georgia adults with health care coverage have a similar diabetes prevalence as compared to those without health care coverage (Table 4).
Health Care Coverage, Georgia, 2008-2010
Figure 6. Percentage of Adults with Diabetes by Health Care Coverage, Georgia, 2008-2010

Any Health Care Coverage

No Health Care Coverage

19%

81%
Data Source:DBaethaavSioruarlcRei:skBeFhacatvoiroSruarlvReiisllkanFcaectSoysrteSmur(v2e0i0ll8a-n2c0e10S)ystem (2008-2010)
15

Disability
Disabled Georgia adults had a diabetes prevalence of 20.5% (290,781 adults), which was nearly 3 times greater than the diabetes prevalence of those who were not disabled (Table 4). The prevalence of diabetes was similar among disabled men and women (Table 5). Disabled Black, Non-Hispanics had a diabetes prevalence 53% greater than White, Non-Hispanics. Disabled adults who were unable to work had a significantly greater diabetes prevalence than employed disabled persons at 31.3% and 11.3%, respectively. Disabled veterans and disabled non-veterans have a similar prevalence of diabetes.

Table 5. Diabetes Prevalence among Disabled Georgia Adults by Demographic Characteristics, 2008-2010

Demographic Characteristics

Prevalence (%, 95% CI)

Estimated Number of Adults

Sex

Male 19.8 (17.4, 22.3)

126,785

Female 21.1 (19.3, 23.0)

163,996

Race/Ethnicity
White, NonHispanic
Black, NonHispanic
Hispanic
Other*, NonHispanic
Age

17.8 (16.3, 19.5) 27.3 (23.8, 31.1) 22.9 (14.8, 33.7) 19.0 (12.2, 28.5)

167,585 97,122 10,749 11,280

18-44

9.3 (6.9, 12.4)

37,894

45-64 23.4 (21.2, 25.8)

144,333

65 and older Employment Status
Employed

27.6 (25.3, 30.0) 11.3 (9.4, 13.6)

107,344 54,752

Out of Work 12.1 (7.6, 18.6)

13,114

Unable to work 31.3 (27.6, 35.2)

103,897

Veteran Status

Veteran 22.2 (19.0, 25.7)

57,449

*Other race includes Asian, Native Hawaiian/Pacific Islander, American Indian/Native Alaskan and multiracial Data Source: Behavioral Risk Factor Surveillance System (2008-2010)
16

Non-Veteran Total

20.2 (18.6, 21.9) 20.5 (19.0, 22.0)

233,161 290,781

Brief Overview: Complications among Adults with Diagnosed Diabetes

Diabetes is a serious medical disease that, if left untreated, can lead to severe, costly and long-term complications such as: heart disease, kidney failure, stroke, peripheral vascular disease (PVD), lower extremity amputations (LEAs) and visual impairments.1, 4-10

Cardiovascular disease is the leading cause of death among individuals with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.1 Diabetes is also the leading cause of kidney failure, accounting for 44% of all new cases of kidney failure nationally in 2008.1 Unmanaged diabetes can increase the risk of chronic kidney disease progressing to kidney failure or end-stage renal disease (ESRD).11 Kidney failure ultimately requires expensive medical interventions such as dialysis or kidney transplantation for patient survival.11

Circulatory problems caused by uncontrolled diabetes can lead to lower limb complications. Amputations of the leg, foot, or toe, as well as

new cases of blindness, are much more likely to occur in individuals with diabetes.1 Nearly two-thirds of all lower extremity amputations in

the United States were directly linked to diabetes.1

Figure 7. Prevalence of Risk Factors for Diabetes

Risk Factors for Diabetes Complications
In addition to improved levels of hemoglobin A1c (HbA1c) or blood glucose (blood sugar) among adults with diagnosed diabetes, blood pressure and cholesterol control reduce the risk for complications such as: heart disease, kidney failure, nerve damage, and vision loss.12
High blood pressure (hypertension), high cholesterol, smoking, and obesity are modifiable risk factors for diabetes complications.

Complications in Georgia Adult Diabetics, 2001 & 2009
Figure 7. P revalence of Risk Factors for Diabetes Complications in Georgia Adult Diabetics, 2001 & 2009

2001 2009

80

73

70

63

60

50

40

64 51

53 43

Prevalence (%)

As of 2009, of Georgia adults with diabetes (Figure 7):
72.8% had hypertension (498,650 adults) 63.9% had high cholesterol (396,498 adults) 52.6% were obese (348,556 adults) 14.0% were current smokers (96,598 adults)

30

23

20

14

10

0 Hypertension High Cholesterol Current Smoker Risk Factor

Obese

Data Source: Behavioral RDisk aFatcatorSSuorvueilrlacnece:SBysteemh(a20v0i1o, 2r0a09l) Risk Factor Surveillance System (2001, 2009)

Table 6. Prevalence of Risk Factors for Diabetes Complications in Georgia Adult Diabetics, 2001 & 2009

Risk Factor

2001 Prevalence % (Number)

2009 Prevalence % (Number)

Percent Change (%)

Hypertension

63.3 (266,889)

72.8 (498,650)

+15.6

High Cholesterol

50.5 (190,349)

63.9 (396,498)

+26.5

Obese

43.3 (172,543)

52.6 (348,556)

+21.4

Currently Smoking 23.3 (97,939)

14.0 (96,598)

-39.9

Between 2001 and 2009, the prevalence of risk factors such as hypertension, high cholesterol, and obesity among diabetics increased. However, this increase was insignificant. In the same time period, the prevalence of currently smoking among diabetics experienced a significant decrease of 39.9% (Table 6).

Data Source: Behavioral Risk Factor Surveillance System (2001, 2009)
17

18

Diabetes is Costly
The total cost of diabetes in Georgia is approximately $5.1 billion.13 This includes medical costs of $3.3 billion due to diabetes and $1.8 billion in lost productivity costs due to diabetes. In 2007, among all Medicaid beneficiaries in Georgia, approximately $3,200 was spent on each person with Diabetes, amounting to $372.6 million being spent on Georgia Medicaid recipients with Diabetes.14 Nationally, in 2008 diabetes and its related complications imposed a high cost on Medicare and its recipients:
non-dialysis-requiring chronic kidney disease (CKD), diabetes, and congestive heart failure accounted for almost 66% of Medicare costs
4.2% of the Medicare population that had diabetes and CKD accounted for 13.4% of Medicare expenditures each Medicare recipient with chronic kidney disease or renal failure who did not progress to dialysis was estimated
at $250,000 per recipient15 As compared to non-diabetics, diabetics utilize more medical resources, including hospital inpatient care, physician office visits, emergency room visits, nursing and home health, prescription drugs and medical supplies.16 Diabetics that control their blood glucose which may improve their quality of life and increase their job productivity by remaining employed longer and lowering absenteeism.17 Additionally, diabetics able to control their A1c may increase their life span and lower their medical costs.4,5
19

20

Diabetes is among the Leading Causes of Preventable Deaths
Diabetes is the 10th leading cause of death among Georgia adults, accounting for nearly 2,000 deaths in 2010. Diabetes is the 7th leading cause of death among Georgia men (988 deaths in 2010) and 10th leading cause of death among Georgia women (979 deaths in 2010).
21

22

References
1C enters for Disease Control and Prevention, Division of Diabetes Translation, "National Diabetes Fact Sheet, 2011" (Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf) 2F raze, T., Jiang J. Burgess, J. Statistical Brief #93. Hospital Stays for Patients with Diabetes, 2008. Rockville, MD: Agency for Healthcare Research and Quality. August 2010 (Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb93.pdf ) 3Behavioral Risk Factor Surveillance System (BRFSS), 2000-2010. 4T he Diabetes Control and Complications Trial Research Group. "The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus." New England Journal of Medicine, Vol. 329. September 30, 1993. No. #14. http://www.nejm.org/doi/pdf/10.1056/NEJM199309303291401 5Gilmer T, O'Connor P, et al: The Cost to Health Plans of Poor Glycemic Control. Diabetes Care 1997;20(12):1847-1853. 6Menzin J, Langley-Hawthorne C, et al: Potential Short-Term Economic Benefits of Improved Glycemic Control. Diabetes Care 2001; 24(1):51-55. 7National Committee for Health Care Quality Assurance. "The State of Health Care Quality": 2007. 8National Committee for Health Care Quality Assurance. "The State of Health Care Quality: Reform, the Quality Agenda and Resource Use": 2010. 9Shetty S, Secnik K, et al: Relationship of Glycemic Control to Total Diabetes-Related Costs for Managed Care Health Plan Members With Type 2 Diabetes. J Manag Care Pharm 2005;11(7):559-64. 10Wagner EH, Sandhu N, Newton KM, et al: Effect of Improved Glycemic Control on Health Care Costs and Utilization. JAMA 2001;285(2):182-189. 11United States Renal Data System (USRDS) Annual Data Report. 2012. (Available at: http://www.usrds.org/2012/pdf/v1_ch7_12.pdf ) 12Centers for Disease Control and Prevention, Division of Diabetes Translation (Data available at: http://apps.nccd.cdc.gov/ddtstrs/default.aspx ) 13A merican Diabetes Association. Economic Costs of Diabetes in the United States in 2007. Diabetes Care 31: 596-615, June 2008. (Available at: http://www.diabetesarchive.net/advocacy-and-legalresources/cost-of-diabetes-results.jsp?state=Georgia&district=0&DistName=Georgia+%28Entire+State%29 ) 14Centers for Disease Control and Prevention, Chronic Disease Cost Calculator (Available at: www.cdc.gov/chronicdisease/resources/calculator/index.htm ) 15National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Chronic Kidney Disease and Kidney Failure: Fact Sheet". National Institutes of Health (NIH). October 2010. (Available at: http://report.nih.gov/nihfactsheets/pdfs/chronickidneydiseaseandkidneyfailure(niddk).pdf ) 16Dall T, Mann S, et al: Economic Costs of Diabetes in the U.S. in 2007. Diabetes Care 2008:31(3):596-615. 17T esta, MA, and Simonson, DC. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: A randomized, controlled, double-blind trial. JAMA 280:1490-96, 1998.
For more diabetes surveillance data, please visit the Georgia Diabetes Prevention and Control Program website: http://health.state.ga.us/programs/diabetes/index.asp
23