Archived
June, 2007 |
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Highlights in Minority Health
November, 2004
NOVEMBER IS DIABETES
AWARENESS MONTH! |
Diabetes mellitus is a group of diseases characterized by high levels
of blood glucose resulting from defects in insulin production,
insulin action, or both1.
If not treated, diabetes can lead to serious problems. Diabetes can
affect the eyes, kidneys, nerves, gums, teeth, and blood vessels.
Diabetes is the leading cause of adult blindness, lower limb
amputations, and kidney failure. It can cause heart disease and
stroke, and even death if untreated2. |
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Type 1 diabetes was previously called
insulin-dependent diabetes mellitus (IDDM) or juvenile-onset
diabetes. Risk factors are less well defined for type 1 diabetes
than for type 2 diabetes, but autoimmune, genetic, and environmental
factors are involved in the development of this type of diabetes3. |
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Type 2 diabetes was previously called
non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset
diabetes. Type 2 diabetes may account for about 90 to 95 percent of
all diagnosed cases of diabetes. Risk factors for type 2 diabetes
include older age, obesity, family history of diabetes, prior
history of gestational diabetes, impaired glucose tolerance,
physical inactivity, and race/ethnicity3. |
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Gestational diabetes is a form of glucose intolerance that is
diagnosed in some women during pregnancy. After pregnancy, 5 percent
to 10 percent of women with gestational diabetes are found to have
type 2 diabetes. Women who have had gestational diabetes have a 20
percent to 50 percent chance of developing diabetes in the next 5-10
years1. |
In 2002, 18.2 million -- 6.3 percent of the population in the United
States -- had diabetes: 13.0 million people had diagnosed diabetes
and 5.2 million people had undiagnosed diabetes. Diabetes was the
sixth leading cause of death listed on U.S. death certificates in
2000. This ranking is based on the 69,301 death certificates in
which diabetes was listed as the underlying cause of death.
Altogether, diabetes contributed to 213,062 deaths1.
About 40 percent of U.S. adults ages 40 to 74, or 41 million people,
currently have pre-diabetes4,
a condition in which blood glucose levels are higher than normal but
not high enough for a diagnosis of diabetes5. |
People aged 65 years or older account for almost 40 percent of the
population with diabetes6.
However, as obesity rates in children continue to soar, type 2
diabetes, a disease that used to be seen primarily in adults over
age 45, is becoming more common in young people. About 150,000
school-aged children and adolescents have diabetes7. |
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EXAMPLES OF HEALTH
DISPARITIES RELATED TO DIABETES |
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African Americans |
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2.7 million or 11.4 percent of all
non-Hispanic blacks aged 20 years or older have diabetes.
On average, non-Hispanic blacks are 1.6
times as likely to have diabetes or impaired fasting glucose, a form
of pre-diabetes, as non-Hispanic whites of similar age1
(age-adjusted rates in 1999-2000 were black non-Hispanic: 21.1
percent; white non-Hispanic: 13.1 percent)8. |
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In 2000, death rates from diabetes were more than twice as high for
African Americans (49.2 per 100,000) as for non-Hispanic whites
(22.1 per 100,000)9. |
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African Americans with diabetes are more likely to develop diabetes
complications and experience greater disability from the
complications than whites with diabetes10: |
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African Americans tend to have a slightly higher prevalence of
visual impairment than whites or Hispanics/Latinos. In 2002, the
age-adjusted prevalence of visual impairment was 19.7 percent for
whites, 20.3 percent for Hispanics/Latinos, and 22.7 percent for
African Americans11. |
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Kidney failure (end-stage renal disease or ESRD) is about four times
more common in African Americans with diabetes than in whites with
diabetes4. In
2001, the age-adjusted incidence of ESRD related to diabetes in the
diabetic population was 504.30 per 100,000 for African American
males (compared to 222.05 per 100,000 for white males) and 356.22
per 100,000 for African American females (compared to 176.36 per
100,000 for white females)12. |
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Amputations of lower extremities (legs and feet) are more common in
African Americans with diabetes4.
In 2001, the age-standardized hospital discharge rate for
nontraumatic lower extremity amputation (LEA)
rate per 1,000 persons with diabetes was 5.2
among African Americans
and 4.4 among whites13. |
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American Indians/Alaska Natives (AI/ANs) |
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14.9 percent of AI/ANs aged 20 years or older and receiving care
from the Indian Health Service (IHS) have diabetes. This compares
with 8.4 percent of the non-Hispanic white population aged 20 years
or older1. |
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In 2000, death rates from diabetes were almost twice as high for AI/ANs
(40.4 per 100,000) as for non-Hispanic whites (22.1 per 100,000)9. |
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At the regional level, diabetes is least common among Alaska Natives (8.2 percent) and most
common among American Indians in the Southeastern United States
(27.8 percent) and southern Arizona (27.8 percent)1.
For example, 50 percent of Pima Indians in Arizona who are between the ages of
30 and 64 have type 2 diabetes14. |
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Compared to 0.25 percent of all people under 20 years of age
in the U.S. who
have diabetes1,
American Indian youths have the highest prevalence of type 2
diabetes. In the 15-to-19-year age group, the current prevalences
were |
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50.9 per 1000 for Pima Indians from Arizona; |
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4.5 per 1000 for all U.S. American Indian populations (reported
cases from the U.S. Indian Health Service outpatient clinics)15. |
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Asians/Pacific Islanders (APIs) |
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6.3 percent of Asian Americans who
participated in the National Health Interview Survey (NHIS) 18 years
of age and over have diabetes16.
Overall, 6.3 percent of the U.S. population has diabetes, and 8.4
percent of the non-Hispanic whites aged 20 and older have diabetes1. |
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In 2000, death rates from diabetes were lowest for AAPIs (16.9 per
100,000) compared with all other races/ethnicities. The group with
the next lowest rates was non-Hispanic whites (22.1 per 100,000)9. |
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In 2002, Native Hawaiian residents of Hawaii aged 20 and older were
approximately 2 times as likely to have diagnosed diabetes as white
residents of Hawaii of similar age1. |
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Hispanics/Latinos |
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8.2 percent of all Hispanic/Latino Americans aged 20 years or older
have diabetes. On average, Hispanic/Latino Americans are 1.5 times
more likely to have diabetes than non-Hispanic whites of similar age1
(2002 figures are Hispanic/Latino males: 7.5 percent, white males:
5.0 percent; Hispanic/Latino females, 6.3 percent, white females:
4.0 percent)17. |
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In 2000, death rates from diabetes were 1.7 times as high for
Hispanics/Latinos (36.7 per 100,000) as for non-Hispanic whites
(22.1 per 100,000)9. |
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About one-third of total diabetes among Hispanic Americans is
undiagnosed. This is similar to the proportion for other
racial/ethnic groups in the United States18. |
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Mexican Americans, the largest Hispanic/Latino subgroup, are almost
twice as likely to have diabetes as non-Hispanic whites of similar
age1
(age-adjusted rates are Mexican Americans: 12.0 percent; white
non-Hispanic: 7.4 percent)8. |
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PROMISING INTERVENTION STRATEGIES |
To reduce the rate of diabetes and its complications among high-risk
minority populations: |
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Increase early screening and early treatment |
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Improve care for control of diabetes and treatment of major
complications, including eye and foot examinations |
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Conduct clinical trials to prevent the onset of type 2 diabetes in
individuals at most risk for developing the disease. Minorities are
most likely to be affected by type 2 diabetes3. |
Because many complications from kidney disease, blindness, and
amputations can be prevented, health care providers should take advantage of their patients’ routine office
visits to conduct foot and kidney exams, and recommend eye
screenings once a year and teach patients to make proper diabetes management a
part of their daily lives3. |
Reducing high blood pressure among people with diabetes could prevent
one-third of diabetes-related eye, kidney, and nerve
diseases3. |
Approximately 60 percent of diabetes-related blindness could be
avoided with good blood glucose control or by early detection and
laser treatments3. |
About half of all lower-extremity amputations can be prevented by
properly caring for feet and by reducing risk factors such as
abnormally high blood sugar, cigarette smoking, and high blood
pressure3. |
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PROGRAMS |
National Diabetes Education Program (NDEP) |
The NDEP is a joint initiative sponsored by the Centers for Disease
Control and Prevention (CDC) and the National Institutes of Health
(NIH). It is based on a partnership of public and private
organizations that are concerned about the health status of their
constituents. The NDEP is designed to improve treatment and outcomes
for people with diabetes, to promote early diagnosis, and to prevent
the onset of diabetes. Program activities are directed to these
audiences: the general public; people with diabetes and their
families; health care providers; and payers and purchasers of health
care and policymakers19. |
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National Hispanic/Latino Diabetes Initiative for Action (NH/LDIA) |
NH/LDIA was created in 1995 by CDC to serve as a blueprint for CDC to
frame interdisciplinary, culturally relevant approaches to control
diabetes and its complications in the U.S. Hispanic/Latino
community. Because it is also a long-range "road map," the
initiative is comprehensive in scope20. |
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Racial and Ethnic Health Disparities Initiatives (REACH 2010) |
REACH 2010 is part of the national initiative to eliminate disparities
in health status experienced by racial and ethnic minority
populations in six priority areas, including diabetes. REACH 2010
supports community coalitions in designing, implementing, and
evaluating community-driven strategies to eliminate health
disparities. Each coalition comprises a community-based
organization and three other organizations, of which at least one is
either a local or state health department or a university or
research organization. The activities of these community coalitions
include continuing education on disease prevention for health care
providers, health education and health promotion programs that use
lay health workers to reach community members, and health
communications campaigns21. |
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United States and Mexico Border Diabetes Prevention and Control
Project |
The US/Mexico Border Diabetes Prevention and Control Project involves
four United States and six Mexican states along the border.
State-based diabetes prevention and control programs are
collaborating with the Mexican states and the Mexico Department of
Health Ministry to devise and implement strategies to reduce the
burden of diabetes among people who live along the border. Diabetes
program representatives for all 10 U.S. and Mexican states met in
August 1998 in Juarez, Mexico, to agree on the protocols to conduct
a household diabetes surveillance study along the U.S./Mexico
border. The group held three other meetings, and many conference
calls, to draft a proposal to request funding from the CDC, the
Office of Minority Health, the Office of International and Refugee
Health, and the Pan American Health Organization (PAHO) (through the
U.S./Mexico Border Health Association)22. |
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Diabetes Intervention Reaching and Educating Communities
Together (Project Direct) |
Project DIRECT is a multiyear community diabetes demonstration
project, funded primarily by the CDC. It is intended to develop,
implement, and evaluate strategies that can be incorporated into
state-based diabetes prevention and control programs nationwide.
DIRECT focuses on an African-American community in southeast
Raleigh, NC. The three main intervention components are health
promotion, outreach, and diabetes care23. |
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FOR MORE INFORMATION |
Centers for Disease Control and Prevention (CDC) |
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Office of Minority Health (OMH) |
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Eliminate Disparities in Diabetes |
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2003
Diabetes Highlight |
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CDC Health Topic: Diabetes |
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National Center for Chronic Disease Prevention and Health Promotion
(NCCDPHP) |
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CDC Diabetes Public Health Resource |
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Data & Trends |
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National Diabetes Education Program National Minority Organizations |
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National Diabetes Fact Sheet |
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Division of Nutrition and Physical Activity |
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White House Presidential Proclamation |
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Food and Drug Administration (FDA) |
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Diabetes Information |
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National Diabetes Fact Sheet |
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Indian Health Service (IHS) |
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Division of Diabetes Treatment and Prevention |
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Medline Plus: Diabetes |
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National Diabetes Education Program (NDEP) |
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National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) |
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Conquering Diabetes: A Strategic Plan for the 21st
Century |
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Diabetes in Select US Populations |
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National Diabetes Information Clearinghouse |
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National Institute of Child Health and Human Development (NICHD) |
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Are You At Risk for Gestational Diabetes? |
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American Diabetes Association |
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SOURCES |
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1. |
Centers for Disease Control and Prevention (CDC),
National Center for Chronic Disease Prevention and Health Promotion
(NCCDPHP), “National Diabetes Fact Sheet, United States, 2003” |
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2. |
National Diabetes Education Program (NDEP), “Diabetes in Children
and Adolescents Fact Sheet” |
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3. |
CDC’s Office of Minority Health (OMH), “Eliminate Disparities in
Diabetes,” 2004 |
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4. |
US Dept. of Health and Human Services (HHS),
Office of Minority Health Resource Center (OMHRC) “Diabetes,” 2004 |
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5. |
National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK),
National Diabetes Information Clearinghouse (NDIC), “National
Diabetes Statistics,” 2004 |
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6. |
CDC, NCCDPHP, Diabetes Public Health Resource (DPHR), “Diabetes
Surveillance System: Prevalence of Diabetes,” 2004
Figure
Table |
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7. |
NDEP, “Resources on Children and Adolescents” |
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8. |
CDC, Morbidity and Mortality Weekly Report (MMWR) “Prevalence of
Diabetes and Impaired Fasting Glucose in Adults, 1999-2000,” 2003,
52(35): 833-837 |
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9. |
CDC, National Center for Health Statistics (NCHS),
Health US, 2003, table 29 |
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10. |
NDIC, “Diabetes in African Americans,” 2002 |
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11. |
NCCDPHP, DPHR, “Diabetes Surveillance System: Vision
Impairment,” 2004
Figure
Table |
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12. |
NCCDPHP, DPHR, “Diabetes Surveillance System: End-Stage Renal
Disease,” 2004
Figure
Table |
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13. |
NCCDPHP, DPHR, “Diabetes Surveillance System: Nontraumatic Lower
Extremity Amputation with Diabetes,” 2004
Figure
Table |
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14. |
The National Women’s Health Information Center (NWHIC), “Health
Problems in American Indian/Alaska Native Women: Diabetes,” 2003 |
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15. |
CDC,
NCCDPHP, DPHR, “Diabetes Projects,” 2004 |
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16. |
CDC,
NCHS, “Summary Health Statistics for U.S. Adults: National Health
Interview Survey (NHIS), 2002,” Vital and Health Statistics 10(22):
30-31 |
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17. |
CDC, NCCDPHP, DPHR, “Diabetes Surveillance System: Prevalence of
Diabetes,” 2002 |
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18 |
NIDDK, “Diabetes in Hispanic Americans,” 2002 |
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19. |
NCCDPHP, DPHR, “About CDC's Division of Diabetes Translation” |
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20. |
NCCDPHP, DPHR, “Diabetes Projects: National Hispanic/Latino Diabetes
Initiative for Action,” 2004 |
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21. |
CDC,
Racial and Ethnic Approaches to Community Health (REACH 2010),
“Goals for 2010,” 2004 |
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22. |
NCCDPHP, DPHR, “Diabetes Projects: US/Mexico Border Diabetes
Prevention and Control Project,” 2004 |
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23. |
NCCDPHP, DPHR, “Diabetes Projects: Project DIRECT,” 2004 |
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