The Assistant Secretary for Health and
the Surgeon General chaired the third and final review of progress in achieving Healthy People 2000 objectives for Diabetes and Other Chronic Disabling Conditions. The review, which focused on diabetes and asthma, was organized by the Centers for Disease Control and Prevention and the National Institutes of Health, which serve as the co-lead agencies for this Healthy People 2000 priority area. The discussions centered on four principal topics:
1) new knowledge in diabetes; 2) health disparities in diabetes; 3) the National Diabetes Education Program; and 4) controlling and preventing asthma. Other chronic conditions covered in this priority area were addressed in earlier progress reviews. The overview and discussion focused on selected objectives and the status of their data in priority areas 17 (Diabetes and Other Chronic Disabling Conditions) and 11 (Environmental
Health) as
follows:
17.4
Activity limitation among people with asthma increased from 20.4 percent in
1988-90 to 22.5 percent in 1991-93, then decreased to 19.6 percent in 1994-96.
The year 2000 target is 10 percent. Among Blacks with asthma, 30.5 percent
experienced activity limitation in 1989-91, compared with 27.0 percent in 1994-96.
The target is 19 percent.
11.1 Asthma
hospitalization rates have dropped 5 percent since 1987 for the total
population, while rates for Blacks have increased 8 percent. In 1996, the rate
for Blacks was twice the rate for the total population.
17.9 The
age-adjusted death rate from diabetes for the total population increased from 38
per 100,000 in 1990 to 41 in 1996. The year 2000 target is 34 per 100,000. Over
the same time period, the rate for Blacks increased from 71 per 100,000 to 76
(target, 58); for American Indians/Alaska Natives, from 46 to 63 (target, 41);
for Mexican-Americans, from 55.7 to 60.1 (target, 50); and for Puerto-Ricans,
from 40.7 to 58.5 (target, 42).
17.10 Among
people with diabetes, the prevalence of end-stage renal disease (ESRD)
increased from 2.5 per 1,000 in 1990 to 4.1 in 1996. The year 2000 target is 1.4
per 1,000. The prevalence of lower extremity amputation in people with diabetes
increased from 8.6 per 1,000 in 1990 to 11.1 in 1996. The target is 4.9. Among
Blacks with diabetes, the prevalence of ESRD due to that condition increased
from 3.1 per 1,000 in 1986-89 to 5.5 in 1993-96 (target, 2.0). The rate of lower
extremity amputations increased in Blacks with diabetes from 8.0 per 1,000 in 1990
to 10.1 in 1996 (target, 6.1).
17.11 The
prevalence of diabetes in the total population increased from 26 per 1,000 in
1988-90 to 31 in 1994-96. The year 2000 target is 25 per 1,000. For Blacks, the
prevalence went from 36 per 1,000 in 1988-90 to 44 in 1994-96 (target, 32).
Among American Indians/Alaska Natives in Indian Health Service areas,
diabetes prevalence increased from 69 per 1,000 (ages 15 and over) in 1987 to 90
per 1,000 (ages 20 and over) in 1996 (target, 62).
17.12
In 1988-94, the age-adjusted prevalence of overweight or obesity (BMI³25)
was 54.9 percent—up from 46 percent in the 1970s and 43.3 percent in
1960-62. Among men, it increased to 59.4 percent in 1988-94, and among women, to
50.7 percent. Among black men and women, the prevalence increased from 43.1
to 56.5 percent and from 57.0 to 65.8 percent, respectively. Prevalence in
adolescents increased from 15 percent in 1976-80 to 24 percent in 1988-94.
DEVELOPMENTS
-
The Diabetes Control and
Complications Trial (DCCT) established that intensive therapy aimed at
keeping blood glucose levels as close to normal as possible in people with
Type 1 diabetes delayed the onset and slowed the progression of diabetic
retinopathy, nephropathy, and neuropathy by 35 to 70 percent.
-
About 500,000
hospitalizations, 5,500 deaths, and more than 100 million days of restricted
activity related to asthma occur each year. Overall, asthma
hospitalization rates have decreased, but among children, rates continue to
increase.
-
Despite the fact that
almost all asthma attacks can be controlled with currently available
therapies under guidelines of the National Asthma Education and Prevention
Program (NAEPP), mortality rates for asthma have increased.
- The
United Kingdom Prospective Diabetes Study (UKPDS) is the largest study of
people with Type 2 diabetes ever performed, lasting 20 years and including
over 5,000 patients. UKPDS findings demonstrate that intensive control of
blood glucose in Type 2 diabetes reduces the incidence of both
retinopathy and nephropathy by 25 percent, compared to standard
treatment. Further, improved control of blood pressure in people with Type 2
diabetes significantly reduced both micro- and macrovascular complications.
DEVELOPMENTS
(Cont.)
-
The current projection is
that, worldwide, there will be nearly 300 million people with diabetes in
2025, most of whom will have Type 2 diabetes. In the U.S., there will be
about 22 million people with diabetes in 2025.
-
The National Health and
Nutrition Examination Survey provides a prevalence estimate that between
one-third and one-half of diabetes cases are undiagnosed.
-
Only Hawaii and
Massachusetts have met the Healthy People 2000 target of having 70 percent
of people with diabetes 18 years of age and older undergo a dilated eye
examination in the previous year.
-
Long-term maintenance of
normal blood glucose control can reverse kidney damage caused by diabetes.
-
The greatest change in the
management of both Type 1 and Type 2 diabetes in the past two decades has
been the introduction and widespread acceptance and use of reliable,
accurate, and relatively user-friendly self-glucose monitoring devices.
-
In a model for other
screening programs, the Veterans Health Administration has instituted risk
stratification of diabetic patients in need of more frequent eye exams.
-
As part of the
President’s Initiative on Race, the Department of Health and Human
Services has focused on reducing rates of ESRD and lower extremity
amputation from diabetes among Blacks and American Indians/Alaska Natives.
The targets in Healthy People 2000 are used in this initiative.
-
Accelerate the translation
of advances in research on diabetes and asthma into clinical practice.
-
Promote the use of NAEPP
Guidelines in clinical practice.
-
Find better ways to
communicate about opportunities to prevent and control diabetes and asthma
and to reduce and eliminate racial and ethnic disparities in those areas.
-
Refine data collection to
make possible an earlier and more complete description of trends in diabetes
and asthma morbidity and mortality.
- Address
the problem of obesity and overweight as predisposing factors for diabetes.
Devise weight control programs that achieve an optimal energy balance,
incorporating elements of both sound nutrition and physical activity. The
CDC Diabetes Prevention Program leads the way in such activity.
PARTICIPANTS
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