On This Page: • At A Glance • Success Stories • Related Materials

DIABETES
Successes and Opportunities for
Population-Based Prevention and Control

At A Glance 2009

What is Diabetes?

Diabetes is a disease in which the body has a shortage of insulin or a decreased ability to use insulin, a hormone that allows glucose (sugar) to enter cells and be converted to energy. When diabetes is not controlled, glucose and fats remain in the blood and, over time, damage vital organs.

• Type 1 diabetes usually strikes children and young adults, although the disease can appear at any age. Type 1 may be autoimmune, genetic, and/or environmental. There is no known way to prevent this type of diabetes.
   
• Type 2 diabetes, which is linked to obesity and physical inactivity, accounts for 90%–95% of diabetes cases and most often appears in people older than 40. Type 2 is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, race, and ethnicity. Type 2 diabetes in children and adolescents, although still rare, is being diagnosed more frequently among American Indians, African Americans, Hispanic/Latino Americans, and Asian/Pacific Islanders.
   
• Prediabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes. An estimated 57 million American adults had prediabetes in 2007. People with this condition have an increased risk of developing type 2 diabetes, heart disease, and stroke.
   
• Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 40% to 60% chance of developing diabetes in the next 5–10 years.
   
• Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, medications, infections, pancreatic disease, and other illnesses. Other types of diabetes account for 1% to 5% of all diagnosed cases.

Diabetes Is Costly

• Total costs (direct and indirect) of diabetes: $174 billion.
   
• Direct medical costs: $116 billion.
   
• Indirect costs (related to disability, work loss, premature death): $58 billion.
   
• People with diagnosed diabetes have medical expenditures that are about 2.3 times higher than medical expenditures for people without diabetes.

Diabetes Is Preventable and Controllable

Recent studies show that lifestyle changes can prevent the onset of type 2 diabetes among those at high risk.

• For those with prediabetes, lifestyle changes, including at least 7% weight loss and at least 150 minutes of physical activity per week, can reduce the onset of type 2 diabetes by 58%.

Disability and premature death are not inevitable consequences of diabetes. Working together, people with diabetes, their support network, and their health care providers can reduce the occurrence of premature death and disability by controlling blood glucose, blood pressure and blood lipids, and by receiving other preventive care practices in a timely manner.

• Blood glucose control reduces the risk for eye, kidney, and nerve diseases among people with diabetes by about 40%.
   
• Blood pressure control reduces the risk for heart disease and stroke among people with diabetes by 33%–50%. It also reduces the risk for eye, kidney, and nerve diseases by about 33%.
   
• Detecting and treating diabetic eye disease with laser therapy can reduce the risk for loss of eyesight by about 50%–60%. Comprehensive foot care programs can reduce amputation rates by 45%–85%.

Important Achievements, But More to Do

There are encouraging outcomes to report in the effort to control the epidemic of diabetes. People with diabetes are living longer and we have also seen decreases in

• Hospitalizations among people with diabetes.
   
• Cardiovascular disease death rates among people with diabetes.
   
• The prevalence of visual impairments among people with diabetes.
   
• The percentage of people with diabetes who are unaware that they have the disease.

[A text description of this map is also available.]

CDC's Response

CDC works to reduce the preventable burden of diabetes through public health leadership, partnerships, research, programs,  and policies that translate science into practice. Through its Division of Diabetes Translation (DDT), CDC is

• Monitoring the diabetes burden through the use of public health surveillance.
   
• Conducting research that helps communities translate findings from clinical trials into clinical and public health practice.
   
• Developing and maintaining effective state-based diabetes prevention and control programs.
   
• Closing health gaps among populations most severely affected by diabetes.

Defining the Diabetes Burden

CDC’s National Diabetes Surveillance System (NDSS) maintains diabetes-related data from national and state-based surveys. NDSS data, available from no other source, have been used to determine trends in diabetes and its complications, identify diabetes health service research needs, develop and monitor national health objectives, detect changes in health care practices, facilitate program planning and educational materials, and allocate resources. For national data as well as data about your state or county, visit http://apps.nccd.cdc.gov/DDTSTRS/.

Translating Research and Conducting New Research

CDC translates research findings from clinical trials and scientific studies for use by health care systems and communities. Special emphasis is placed on the elimination of disparities. Examples of research in action include:

• Translating Research Into Action for Diabetes (TRIAD). A national, multicenter study, TRIAD aims to provide practical information on how to better implement effective treatments and provide better care for diabetic patients in U.S. managed care settings.
   
• Primary Prevention for People Most at Risk. CDC is conducting primary prevention pilot programs in five states to identify people at high risk for type 2 diabetes to develop policies to help these people reduce their risk, and to establish public health programs that will slow the diabetes epidemic.

Developing State- and U.S. Territory-Based Programs

CDC provides funding and technical assistance for state-based diabetes prevention and control programs (DPCPs) in all 50 states, the District of Columbia, and eight current and former U.S. territories.

These programs implement public health strategies such as

• Preventing diabetes among individuals at highest risk.
   
• Health care delivery settings adopting diabetes care guidelines.
   
• Helping state Medicaid programs monitor quality care outcomes among persons with diabetes.
   
• Educating providers and the public about optimal diabetes care and self-management.
   
• Involving communities in diabetes control activities.

Providing Education and Sharing Expertise

Two programs in DDT that focus on disparate populations are the National Diabetes Education Program (NDEP) and the Native Diabetes Wellness Program (NDWP). The NDEP, jointly led by CDC and National Institutes of Health (NIH), develops and disseminates educational information on the prevention and control of diabetes for populations affected by diabetes, health care professionals, employers, and insurers. NDEP’s educational resources and tools are available in English, Spanish, and 15 Asian and Pacific Islander languages at http://www.ndep.nih.gov. The NDEP Web site also provides resources that target specific audiences such as business and managed care companies and health care providers.

The NDWP focuses on the American Indian/Alaska Native and Pacific Islander populations who are disproportionately affected by diabetes. The NDWP and its partners developed a series of children’s books (Eagle Books), which use the native art of story-telling to teach children about returning to traditional, healthy lifestyle practices. More than 2 million copies of Eagle Books have been provided to schools, libraries, and other organizations. More information on the books can be found at http://www.cdc.gov/diabetes/pubs/eagle.htm.

Back to top

Success Stories

Alaska: Expanding Access to Chronic Disease Self-Management Education Through “Living Well Alaska”

As the Alaskan population ages, chronic disease prevalence, risk factors, and comorbidities are increasing at an alarming rate. Alaska Behavioral Risk Factor Surveillance data show a 10% increase in the number of people diagnosed with diabetes during 2002–2006. If this trend continues, the number of Alaskans diagnosed with diabetes (currently 24,500) will increase significantly. The geography and climate of Alaska restrict access to care and increase the cost of health care. About one-fourth of all Alaskans and nearly half (46%) of Alaska Natives live in communities of less than 1,000 people. Seventy-five percent of Alaskan communities are not connected by road to a hospital. Air travel in the state is very expensive, and many rural residents have little income. Severe weather further limits air travel, causing delays in obtaining care. As a result, many Alaskans with diabetes have limited access to self-management education and support.

To address this problem, funding was provided to the Alaska Diabetes Prevention and Control Program (AK DPCP) by CDC’s Division of Diabetes Translation to support dissemination of a proven chronic disease self-management program (CDSMP). Arthritis funding was added, expanding the reach of the initiative and ultimately creating the “Living Well Alaska” program. In 2006, program staff collaborated with Stanford University to train 37 master trainers in 2006. Twenty of these trainers facilitated participant workshops in Anchorage, Juneau, Soldotna, and Talkeetna, reaching 114 participants. The AK DPCP coordinated the initial master trainer workshop and continues to evaluate the effectiveness of workshops.

Since 2006, the program has been conducted with promising results in nine different community health centers and two senior citizen centers across the state. An additional master trainer program will be conducted in 2008–2009, which is expected to generate 50 new course leaders. Through participation in these trainings, health care providers and patients are increasing their competencies related to self-management of chronic diseases.

As “Living Well Alaska” extends its reach to more sectors and regions of the state, the program has the potential for large-scale impact, increasing access to self-management education for people with diabetes and other chronic diseases.

North Dakota: Partnership Develops a Diabetes Management and Quality Improvement Initiative

Diabetes is a significant public health burden for North Dakota residents. More than 29,000 people in North Dakota have diabetes, resulting in more than 9,400 hospitalizations and 665 deaths each year. In 1999, the North Dakota Diabetes Prevention and Control Program (DPCP) contracted with Blue Cross/Blue Shield (BC/BS) of North Dakota to develop the Diabetes Management and Quality Improvement Initiative.

As part of this initiative, quarterly provider reports were sent to approximately 600 physicians in which they provided details of care for each of their patients. Since the initiation of the Diabetes Care Provider Report, the percentage of providers who documented that their patients received all five preventive care measures increased from 13% to 45%.

As a result of the Diabetes Management and Quality Improvement Initiative, BC/BS expanded the program to include other chronic diseases and initiated a chronic disease management pilot at one of the largest clinics in North Dakota. Significant findings included the following:

• A 24% decrease in emergency room visits.
   
• Up to a 15% improvement on ambulatory care measures including A1C, lipid and microalbumin tests, and eye exams.
   
• A cost savings of about $530 per patient.

In 2009, the DPCP will be partnering with BC/BS as they expand this program statewide to include all primary care physicians who are able to provide a similar “Medical Home” system of care. The project will be called MediQhome, and will include all patients cared for by the participating providers—not just those insured by BC/BS. The expanded project is projected to cover up to 80% of all patients in the state. This is an excellent example of a DPCP working through the Model of Influence with partners to achieve statewide impact on the care provided for people with diabetes and other chronic diseases.

Texas: Targeting Populations With—and at Highest Risk For—Diabetes

An estimated 1.8 million, or 10.30% of Texans aged 18 years and older have been diagnosed with diabetes. Diabetes is the fourth leading cause of death among African Americans and Hispanics; rates are highest among black non-Hispanic (10.3 %) and Hispanic populations (8.0%). Further, an estimated 460,040 persons aged 18 and older are believed to have undiagnosed diabetes. It is estimated that during the next 30 years, the total number of diabetes cases in Texas will increase by 77%, from 1.3 million in 2005 to almost 2.3 million in 2040.

CDC’s funding assisted the Texas DPCP’s development of 17 community-based diabetes prevention and control programs. These programs bring culturally appropriate diabetes education and prevention messages to those at greatest risk for diabetes and its complications. Target populations include racial and ethnic minorities with previously noted disproportionate rates of diabetes and diabetes complications and limited access to health care services.

The following changes occurred as a result of the community-based programs:

• Increased opportunities for physical activity and better nutrition with the implementation of 81 ongoing physical activity groups and 81 sustained nutrition programs.
   
• Increased access to self-management education, with a total of 249 classes.
   
• Improved capacity of coalition–based community programs to design and implement diabetes interventions (344 key partners were recruited and maintained by community programs throughout all regions of the state).
   
• Since September 1, 2007, these efforts have reached more than 62,000 Texans (19% African American and 48% Hispanic) across multiple sectors including health systems, senior citizen centers, businesses, faith-based organizations, nonprofit organizations, and schools.

On the front line of health promotion, community-based diabetes programs expand the reach of all elements of the comprehensive state diabetes program supported by the CDC. Recognized for their local efforts, these programs are becoming sought-after resources for translating statewide and national initiatives to the geographic areas they serve.

Back to top

Related Materials

• Diabetes—At A Glance 2009 (PDF–3.4Mb)
• Diabetes—Success Stories (PDF–1Mb)
• CDC's Diabetes Web Site
• Preventing Diabetes and Its Complications
• State and Program Examples (118K–PDF)

Back to top

One or more documents on this Web page is available in Portable Document Format (PDF). You will need Acrobat Reader (a free application) to view and print these documents.

Page last reviewed: February 12, 2009
Page last modified: February 12, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion