Diabetes: The Epidemic of the 21st Century
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Diabetes: The Epidemic of the 21st Century. A Managed Care Perspective: The Arizona Experience Roberto Ruiz, M.D., F.A.C.P. Arizona Demographics. Total Number of Residents 6,440,990 White 58% Hispanic31% American Indian 8% Black 4%. statehealthfacts.org.

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Diabetes: The Epidemic of the 21st Century

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Powerpoint presentation

Diabetes: The Epidemic of the 21st Century

A Managed Care Perspective: The Arizona Experience

Roberto Ruiz, M.D., F.A.C.P.


Arizona demographics

Arizona Demographics

Total Number of Residents 6,440,990

White 58%

Hispanic31%

American Indian 8%

Black 4%

statehealthfacts.org


Arizona demographics1

Arizona Demographics

Health Insurance Coverage (2007-2008)

Employer47.0%

Individual 4.7%

Medicaid 16.8%

Medicare11.4%

Other Public 1.2%

Uninsured18.9%

Statehealthfacts.org


Arizona demographics2

Arizona Demographics

  • Arizona has seen a 44 percent increase in adults with diabetes from 2000 through 2006

  • prevalence rising from 5.9 percent to 8.5.

  • In Arizona, 9.2 percent of Hispanics have diabetes whereas 7.8 percent of non- Hispanic Whites have diabetes.

Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition


Powerpoint presentation

Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition


Powerpoint presentation

Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition


Arizona demographics3

Arizona Demographics

Diabetes RelatedDischargesHospital InpatientDischarges

2005 2008 2005 2008

Totals 175,786 209,265 99,111 108,662

< 15 1,197 1,221

15-19 1,495 1,983

20-44 31,750 39,494

45-64 65,658 80,774

65+ 75,685 85,793

Maricopa 97,208 120,578 55,919 62,076

Arizona Department of Health Services


Arizona demopgraphics

Arizona Demopgraphics

Emergency Room Visits

2005 2008

Totals 76,675 100,603

< 15 722 725

15-19 883 1,210

20-44 19,123 25,320

45-64 29,491 40,288

65+ 26,455 33,060

Maricopa 41,289 58,502

Arizona Department of Health Services


Arizona demographics4

Arizona Demographics

Patient Days for Inpatient Discharges for Diabetes

2005 2008

Totals 44,637 47,679

< 15 1,095 1,191

15-19 997 1,372

20-44 10,047 11,657

45-64 17,615 19,187

65+ 14,883 14,272

Maricopa 22,263 26,567

Arizona Department of Health Services


Arizona demographics5

Arizona Demographics

Patient Days for Inpatient Discharges for Diabetes

2005 2008

American Indian(6.2) 4,560 4,795

Black or African American (4.5)2,420 3,010

Hispanic (4.9)10,896 12,067

White (4.8)24,974 26,431

Arizona Department of Health Services


National diabetes 2007

National Diabetes - 2007

Prevalence of Impaired Fasting Glucose in People < 20 in U.S.

In 1999 – 2000, 7% had IFG

In 2003 - 2006, 25.9% of Adults 20 yrs. or older had IFG

35.4 % of Adults age 60+ had IFG

Applying this percentage to the entire U.S. population in 2007 yields an estimated 57 million American adults aged 20 yrs. Or older, suggesting that at least 57 million American adults had pre-diabetes in 2007

National Diabetes Clearinghouse (NDIC)


National diabetes 20071

National Diabetes - 2007

Prevalence of Diagnosed and Undiagnosed Diabetes in 2007

Total 23.6 Million people7.8 % of population have diabetes

Diagnosed 17.9 million people

Undiagnosed 5.7 million people

National Diabetes Clearinghouse (NDIC)


National diabetes 20072

National Diabetes - 2007

NHW=Non-Hispanic Whites; AA=African Americans; H=Hispanics; API=Asians/Pacific Islanders; AI=American Indians

Source: SEARCH for Diabetes in Youth Study.


Complications of diabetes in the united states

Complications of Diabetes in the United States

In 2004, heart disease was noted on 68 percent of diabetes-related death certificates among people ages 65 years or older.

In 2004, stroke was noted on 16 percent of diabetes-related death certificates among people ages 65 years or older.

Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.

The risk for stroke is two to four times higher among people with diabetes.

National Diabetes Clearinghouse (NDIC)


Complications of diabetes in the united states1

Complications of Diabetes in the United States

In 2003 to 2004, 75 percent of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or used prescription medications for hypertension.

Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74 years.

Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

National Diabetes Clearinghouse (NDIC)


Complications of diabetes in the united states2

Complications of Diabetes in the United States

Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2005.

In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.

In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

National Diabetes Clearinghouse (NDIC)


Complications of diabetes in the united states3

Complications of Diabetes in the United States

About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, erectile dysfunction, or other nerve problems.

Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

National Diabetes Clearinghouse (NDIC)


Complications of diabetes in the united states4

Complications of Diabetes in the United States

More than 60 percent of nontraumatic lower-limb amputations occur in people with diabetes.

In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes.

National Diabetes Clearinghouse (NDIC)


Complications of diabetes in the united states5

Complications of Diabetes in the United States

Periodontal, or gum, disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.

People with poorly controlled diabetes—A1C greater than 9 percent—were nearly three times more likely to have severe periodontitis than those without diabetes.

Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more.

National Diabetes Clearinghouse (NDIC)


Complications of diabetes in the united states6

Complications of Diabetes in the United States

Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5 to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies.

Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

National Diabetes Clearinghouse (NDIC)


Complications of diabetes in the united states7

Complications of Diabetes in the United States

Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar, or nonketotic, coma.

People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

National Diabetes Clearinghouse (NDIC)


Powerpoint presentation

A closer look at my patients……

Southwest Internal Medicine Group


Age distribution

Age Distribution


Hba1c distribution

HbA1c Distribution


Hba1c

HbA1c

  • Average HbA1c for the Southwest Internal Medicine Group is 6.4

  • Average HbA1c for the Nation is 9.0


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