Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 5-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

All but 1 of the 15 objectives remaining at the time of the midcourse review were measurable. Three objectives met or exceeded the targets, six moved toward targets, four moved away from targets, and one showed no movement.

Objectives that met or exceeded their targets. Three objectives exceeded their targets: diabetes-related deaths among persons with diabetes (5-6), cardiovascular deaths in persons with diabetes (5-7), and annual urinary microalbumin measurements in persons aged 65 years and older with diabetes (5-11). Regarding the objectives for diabetes-related deaths and diabetes-related cardiovascular deaths, progress reflected the increasing attention now paid to cardiovascular risk factors, including blood lipid levels, high blood pressure, aspirin use, and heart attack treatments among those with diabetes.

A collaboration between the American Cancer Society, American Heart Association, and American Diabetes Association was initiated in June 2004. The collaboration creates a national commitment to the prevention and early detection of cancer, cardiovascular disease, and diabetes and reflects the increased emphasis on prevention of these diseases.¹⁶

Objectives that moved toward their targets. Six objectives moved toward their targets: diabetes education for persons aged 18 years and older (5-1), diagnosis of diabetes in persons aged 20 years and older (5-4), lower extremity amputations for persons with diabetes (5-10), hemoglobin A1c testing for persons aged 18 and older with diabetes (5-12), annual dilated eye exams (5-13), and daily self-blood-glucose-monitoring (5-17). Several of these objectives fell under the transitional point of improved quality of care. Individual and collective efforts of the public, private, academic, and professional communities contributed to this progress. Along with academic and industry developments, the National Diabetes Quality Improvement Alliance (Alliance), founded in 1997 as the Diabetes Quality Improvement Project, worked toward influencing change. The Alliance established a comprehensive set of national measures for assessing the quality of diabetes care, which have been incorporated into the Health Plan Employer Data and Information Set, the American Diabetes Association Provider Recognition Program, the American Medical Association Diabetes Measures Group, and the U.S. Department of Veteran Affairs' performance monitoring program. Other programs working to improve the quality of diabetes care are longstanding and include the National Diabetes Education Program (NDEP), the National High Blood Pressure Education Program, and the National Cholesterol Education Program.¹⁷

Objectives that demonstrated no change. Annual foot examinations in persons aged 18 years and older with diabetes (5-14) neither moved toward its target nor regressed from it.

Objectives that moved away from their targets. Four objectives moved away from their targets: new cases of diabetes in persons aged 18 to 84 years (5-2), overall cases of diagnosed diabetes (5-3), diabetes-related deaths (5-5), and annual dental exams for people aged 2 years and older with diabetes (5-15). For new and overall cases of diabetes (5-2 and 5-3), the movement away from the targets was a reflection of improved disease identification and diagnosis by health care providers, demographic changes,¹ and greater obesity.¹⁸ This trend will continue unless primary prevention programs can be widely implemented and companion efforts to improve care are sustained for persons already affected. Factors associated with the decrease in yearly dental examinations (5-15) are not clear. NDEP has specifically targeted dental care and dental professionals for better diabetes management.¹⁹

Objectives that could not be assessed. Tracking data were not available to measure progress for aspirin therapy in persons with diabetes (5-16). Additional data to assess the trend are anticipated by the end of the decade.

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