DIABETES IN ALABAMA

1. DIABETES IN ALABAMA Presented By: Donald Williamson, M.D. State Health Officer Alabama Department of Public Health

2. Questions to be answered: • What is Diabetes Mellitus? • What is the burden of diabetes in Alabama? • What do we need to do?

3. What Is Diabetes Mellitus? • Diabetes is a disease in which blood glucose levels are above normal. • Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy.

4. Diabetes • The body does not make enough insulin, or • The body can not use its own insulin as well as it should.

5. Diabetes Type 1 Usually occurs in children and adults under age 30. The body does not make insulin, therefore patients must take insulin to live. Type 2 Usually occurs in adults over age 40. The body does not make enough or can not use the insulin it makes adequately.

6. Risk Factors • Obesity • Age • Lack of exercise • Family history • History of gestational diabetes • Impaired glucose tolerance • High blood pressure • High cholesterol

7. Symptoms of Diabetes • Frequent urination • Excessive thirst • Unexplained weight loss • Extreme hunger • Sudden vision changes • Tingling or numbness in hands or feet • Feeling very tired much of the time • Very dry skin • Sores that are slow to heal • More infections than usual.

8. 2007 BRFSS

9. More than20 millionpeople in theUnited States have diabetes American Diabetes Association

10. What Is the Burden Of Diabetes In Alabama? • Based on the 2007 BRFSS data, more than360,912people in Alabama are aware they have diabetes • As many as 200,000 more may have diabetes and do not know that they have it

11. One in ten adults have been diagnosed with diabetes Alabama is ranked fifth in prevalence of diabetes in the United States and its territories In Alabama

12.  At least54 millionpeople in the United States have what is referred to as “pre-diabetes”The growing number of overweight Americans is leading to an increased incidence of metabolic syndrome American Diabetes Association

13. Metabolic Syndrome • A disorder that often includes high blood pressure, high cholesterol and high blood sugar • A cluster of health problems that increases the risk for type 2 diabetes American Dietetic Associationhttp://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_4505_ENU_HTML.htm

14. Risk Factors • A waist measuring greater than 40 inches for men and 35 inches for women • Triglyceride levels equal to or greater than 150 milligrams per deciliter

15. HDL (good cholesterol) levels of less than 40 milligrams per deciliter in men and less than 50 milligrams per deciliter in women Blood pressure 130/85 millimeters of mercury or higher Blood sugar 110 milligrams per deciliter or higher

16. Diabetes Prevalence in Alabama by Race 20.0% 15.0% White Percent 10.0% Black 5.0% 0.0% 2001 1999 2000 2002 2003 2005 1995 1996 1997 1998 2006 2007 2004 Year 2007 BRFSS

17. Diabetes in Alabama by Race and Age, 2007 35.0% 30.0% 25.0% 20.0% White Percentage Black 15.0% 10.0% 5.0% 0.0% 18-24 25-34 35-44 45-54 55-64 65+ Age Groups 2007 BRFSS

18. 2007 BRFSS

19. In Alabama • Nearly 80 percent of Alabama adults reported not eating enough fruits and vegetables • Approximately 15 percent of Alabama teens reported that they ate the recommended 5 or more servings per day of fruits and/or vegetables. These proportions were substantially below the national averages BRFSS 2005 YRBS (grades 9 through 12)

20. Top 10 Leading Causes of Death In Alabama 2006 ADPH, Center for Health Statistics

21. The Financial Impact of Diabetes In the U.S. • The financial burden of diabetes in the United States was more than $174 billion in 2007 • In 2007, individuals with diagnosed diabetes incur average expenditures of $11,744 per year, of which $6,649 is resulting from diabetes ADA

22. Financial Aspects of Diabetes in Alabama • 9.54% of diabetics reported no health coverage • 18.34% at some time within the past 12 months had been unable to afford a visit to the doctor 2007 BRFSS

23. People with Prediabetes Undiagnosed onset Diabetes People with Deaths People with Normal Diagnosed Glycemic Diabetes Levels Recovery Deaths What Do We Need To Do? DiabetesOnset Diagnosis People with Prediabetes Reduce burden Maintain pre-diabetic levels Maintainhealthy glycemic levels Live longer Diagnosed Recover to healthy glycemic levels Better quality of life Cost savings (hospitalizations) Lower rate of prevalence Prevention -------------------------------------------------------------------- Management

24. Alabama Diabetes Indicators 2007 BRFSS 2007

25. Strategies for Individuals with Diabetes Check feet daily Maintain daily self-monitoring glucose records Obtain A1C test (twice a year if at goal with stable glycemia) Obtain dilated eye exam (if normal, an eye care specialist may advise an exam every 2–3 years) Obtain dental/oral exam at least once a year Receive the influenza vaccination

26. Obtain pneumococcal vaccination (repeat if over 64 or immunocompromised and last vaccination was more than 5 years ago) Continue healthy eating Obtain urine test for albumin-to-creatinine ration as recommended by physician Be active Do not smoke

27. Strategies to Prevent or Delay Diabetes • Achieve and maintain a healthy weight • Be more physically active • Maintain a healthy blood pressure • Eat a healthy diet • Have cholesterol checked and keep it low • Stop Smoking

28. Sources of Data • Alabama Department of Public Health • American Diabetes Association • American Association of Diabetes Educators • Behavioral Risk Factor Surveillance System (BRFSS) • Centers for Disease Control and Prevention • Clinical Diabetes Journals.org • National Diabetes Education Program • American Dietetic Association For more information about diabetes in the state, visit the Alabama Department of Public Health’s Diabetes Branch web site http://www.adph.org/diabetes

29. ALABAMA Thank You Thank You