Key Diabetes Trends Across Texas 2016

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1 Texas Business Group on Health presents Snapshot of Key Diabetes Trends Across Texas 2016 Diabetes, along with its sibling - Obesity are costly and serious epidemics, that continue to pose significant public health challenges for our health care system, the economy, and employers alike. Every 19 seconds someone in the U. S., aged 20 years or older, is diagnosed with Diabetes.1,4 Comorbidities with behavioral health conditions and other chronic diseases are numerous and in most cases preventable. Diabetes complications, falls in the top 3 of the highest-cost conditions in Texas.5 Employers, along with the health care stakeholder community and the nation must continue to join forces to battle the social and economic burden of Diabetes and its sibling epidemic - Obesity. B G H.OR G + Prevalence and Scope Quality of Care Economic Burden The Texas Business Group on Health (TBGH) is pleased to bring you the 2016 Snapshot of Key Diabetes Trends Across Texas, focusing on the Prevalence, Scope, Quality of Care and the Economic Burden of Diabetes. The Snapshot also highlights Standards of Medical Care and health care resource costs attributable to Type 2 Diabetes for Texas, Dallas, Austin, Fort Worth, Houston and San Antonio, as compared to the nation and includes a Call-To-Action for Employers. Supported by +

2 Diabetes: Prevalence and Scope A1 A Growing Epidemic 1,2,6,9,10,13 A2 Prevalence and Incidence 1,5 Obesity; prediabetes; Weight/BMI/Waistline; Diabetes Complications; Diabetes related Deaths DECREASING Physical Activity; Glucose, BP and Cholesterol Control DIABETES 29.1 Million 1,2,4 in U.S. PREDIABETES 86 Million 1,2,4 in U.S. Direct & Indirect Costs; ER visits, Hospitalizations, Physician Office Visits, Hospital Outpatient Services; and Workplace Absenteeism INCREASING A3 Obesity (a major risk factor) Obesity is linked to the development of diabetes in the U.S. and is also considered a growing epidemic. Obesity is one of the biggest drivers of preventable chronic diseases and healthcare costs in the United States and is also linked to heart disease, hypertension, arthritis, cancer, sleep apnea and many others % of Texans with Diabetes are Obese, % of Texans with Diabetes are Overweight or Obese, Self-Monitoring/Compliance & Management Healthy Eating and Lifestyle; Workplace Productivity 2.5 Million 5 in Texas 1 out of every 11 people has Diabetes 4 1 out of 4 people do not know they have Diabetes 4 1 out of 3 people will develop Diabetes in their lifetime 4 More than 1 out of 3 adults has Prediabetes 4 A4 Complications 7.1 Million 5 in Texas 9 out of 10 people with Prediabetes do not know they have it 4 Within the next 5 years, 15-30% of people with Prediabetes will develop Type 2 Diabetes 4 The risk of heart attack and death from heart disease nearly doubles with Diabetes. 1,3 People with Diabetes have a higher risk for many types of cancer (e.g., pancreas, colon, bladder, breast, uterus and liver). 8 Diabetes is the leading cause of new cases of blindness among working-age adults. 1,3 People with Diabetes are twice as likely to develop depression. 1,3 Diabetes is the leading cause of kidney failure or end-stage renal disease (ESRD), requiring dialysis or a transplant. 1,3 People with Diabetes have a 50% Higher risk of death. 1,2,4

3 Diabetes: Quality of Care B1 Optimal Care Management Better control and management of the A, B, C s of Diabetes reduces costs and chronic complications. 1,2,3 A1c Control Can reduce microvascular (eye, kidney & nerve) complications by 40% Blood Pressure Control Can reduce Heart Disease and Stroke by 33-50% and microvascular (eye, kidney & nerve) complications by 33% Cholesterol Control (LDL, HDL and Triglycerides) Can reduce Heart Disease by 20-50% Foot care education & preventive therapy 59% professional, Preventive Care Practices - 1, 2, 3, 7 Comprehensive Foot Care programs. B3 Testing Rates Risk Assessments Can decrease lower-limb Amputations Treatment of foot problems & referrals to specialists of Texas adults aged 18 years with diabetes reported receiving an annual Foot Exam by a healthcare Percentage of Type 2 Diabetes Patients, by Service, B2 Chronic complications from Diabetes drive up healthcare costs and put a strain on our healthcare system and resources 9 Chronic Complications Neurological symptoms 28% Peripheral vascular disease 30% Atherosclerotic cardiovascular disease (ASCVD) 27% Diabetic kidney disease complications 29% Endocrine complications 11% Diabetic retinopathy (Eye) complications 21% Other complications (e.g., infections, etc.) -27% NOTE: Percent of Category Expenditures Healthcare Resource/Setting Hospital inpatient days Physician office visits Emergency department visits Hospital outpatient visits Outpatient medications and supplies (e.g., eyewear, orthopedic items, hearing devices, prosthesis, bathroom aids, medical equipment, disposable supplies, etc.) Note: An estimated 43.1 million hospital inpatient days are incurred by people with Diabetes and 26.4 million days are attributed to Diabetes. B4 Diabetes Recommended Tests/Exams 1,2,7,11,12 Test/Exam Every Visit Every 3-6 months Yearly Yearly or *3-6 months, if abnormal Tests A1c Glucose Nation 73.90% 86.70% TX 69.50% 84.10% DAL 68.80% 84.30% AUS 78.60% 89.40% FW 66.20% 81.40% HOU 68.10% 81.60% SA 67.60% 83.70% A1c Cholesterol (Lipid Profile) Kidney Function Eye Exam (Lipid Profile) Cholesterol 84.40% 80.30% 79.40% 86.40% 78.30% 78.40% 79.40% Comprehensive Foot Exam Kidney Function 71.40% 63.10% 62.50% 67.00% 61.90% 61.40% 62.80% Weight/BMI/Waist Eye Exam 69.70% 63.80% 62.80% 60.30% 64.00% 63.00% 65.70% Blood Pressure Dental Exam (6 mos.) Texas and top MSAs across the state fell below the nation again in Standards of Medical Care recommended tests, with the exception of Austin on 3 of the 5 tests profiled. This lapse in testing can lead to poor control, sub-optimal care management and costly health complications, increasing the risk of morbidity and mortality in patients with Diabetes. Smoking Cessation (Counseling) Immunizations: Flu Shot, **HepB (series upon Dx), and if 65 years Pneumococcal Pneumonia

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5 References: TBGH 2016 Snapshot of Key Diabetes Trends Across Texas Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, Atlanta, GA: U.S. Department of Health and Human Services; Available from Accessed 4/13/2016. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Diabetes 2014 Report Card. Available from Accessed 4/14/2016. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Available from Accessed Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. CDC: Diabetes Infographic A Snapshot -Diabetes in the United States. Available from Accessed Texas Department of State Health Services. Chronic Disease Prevention in Texas. Presentation to the Senate Committee on Health and Human Services by Commissioner John Hellerstedt, MD and Janna Zumbrun, Assistant Commissioner Div. for Disease Control and Prevention Services. 2/18/2016. Available at Accessed 4/14/2016. Centers for Disease Control and Prevention. Division of Diabetes Translation. U.S. Diabetes Surveillance System. Risk Factors for Complications Texas Adults with Diabetes, Available from Accessed Centers for Disease Control and Prevention. Division of Diabetes Translation. U.S. Diabetes Surveillance System. Preventive Care Practices Texas Adults with Diabetes, Available from Accessed American Diabetes Association Checkup America: What You Need to Know: Diabetes & Cancer. Available from Accessed 4/14/2016. Yang, W., Dall, T., Halder, P., Gallo, P., Kowal, S., & Hogan, P. Economic Costs of Diabetes in the US in Diabetes Care, Volume 36: , American Diabetes Association. Available from Accessed 4/13/16. Sanofi U.S. in partnership with Texas Business Group on Health. Texas Type 2 Diabetes Report, 2015, 10th Edition. Managed Care Digest Series Texas Department of State Health Services Texas Diabetes Council: Diabetes Minimum Practice Recommendations for Children and Adults, Available from Accessed 4/14/2016. American Diabetes Association. Standards of Medical Care in Diabetes 2016: Summary of Revisions. Diabetes Care. 2016; 39 (supplement 1): S1-S Available from Accessed Cawley J, Rizzo JA, Haas K. Occupation specific Absenteeism Costs Associated with Obesity and Morbid Obesity. Journal of Occupational and Environmental Medicine, 49 (12): , Available at Accessed 4/13/2016. American Diabetes Association Common Reasonable Accommodations for Individuals with Diabetes, Available from ns-in-the-workplace/common-reasonable-accommodations.html. Accessed 4/14/2016.