Diabetes: A Costly Problem

Transcription

1 NCSL Legislative Summit - July 23, 2009 Diabetes: Taming a Spreading Disease Ann Albright, PhD, RD Director, Division of Diabetes Translation Centers for Disease Control and Prevention The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC. 24 million with Diabetes 57 million with Prediabetes 1

2 1 in 3 Americans born in 2000 are expected to develop diabetes sometime during their lifetime Narayan, Boyle, Geiss, Saaddine, Thompson. Diabetes Care29(9): , 2006 Diabetes: A Costly Problem Increasing Economic Burden Health Care Expenditures Per Person 2007 $98 Billion 1997 $174 Billion 2007 $5,095 persons without diabetes $11,744 persons with diabetes Dall, T. et al. Economic Costs of Diabetes in the U.S. in 2007 Diabetes Care 31: , 2008.

3 Division of Diabetes Translation Tracking the disease burden Conducting applied translation research to prioritize effective interventions Economic analyses Developing and maintaining state-based diabetes prevention and control programs Implementing National Program Initiatives: National Diabetes Education Program Native Diabetes Wellness Program Ecological Model Community and policy System, group, culture Family, friends, small group Individual The health of individuals is inseparable from the health of communities (Healthy People 2010)

4 Age-adjusted Percentage of U.S. Adults with Obesity or Diagnosed Diabetes Diabetes No Data <4.5% % % % >9.0% Obesity (BMI 30 kg/m 2 ) No Data <14.0% % % % >26.0% Estimated Age-Adjusted * Prevalence of Diagnosed Diabetes in People Aged 20 Years or Older, by Race/Ethnicity, United States, 2007 American Indians/Alaska Natives Non-Hispanic blacks Hispanic/Latino Americans Asian Americans Non-Hispanic whites CDC, National Diabetes Fact Sheet, Percent *Based on the 2000 US standard population

5 Tracking Diabetes: State by State Tracking Diabetes: County Level Estimates Available Spring 2008

6 Tracking Diabetes: SEARCH for Diabetes in Youth Prevalence (p er 1, 000) Years Years NHW AA H API AI T1 T2 T1 T2 SEARCH Study Group, Pediatrics, 2006 Opportunities to Control Diabetes Eye exams lead to 50-60% decrease Vision Loss Foot exams lead to 45-85% decrease Foot Ulcers and Amputations Glucose control lead to 40% decrease Kidney Failure, Vision Loss Lipid control lead to 20-50% decrease Cardiovascular Disease Flu vaccine Narayan et al leads to 32% decrease Hospitalization

7 > 2 A1c Tests in the Last Year 2000 and Age-adjusted rates per 100 adults with diabetes. Centers for Disease Control and Prevention. Diabetes Surveillance System at Foot Exam in the Last Year 1995 and Age-adjusted rates per 100 adults with diabetes. Centers for Disease Control and Prevention. Diabetes Surveillance System at

8 Eye Exams in the Last Year 1995 and Age-adjusted rates per 100 adults with diabetes. Centers for Disease Control and Prevention. Diabetes Surveillance System at Progress in Control: Diabetes Outcomes 1995 to 2005 Vision Loss 25% Amputation 36% End Stage Renal Disease 23% CVD Hospitalization 16% Total Hospitalization 33%

9 Persons with Diagnosed Diabetes Total Population

10 Prevention of Type 2 Diabetes The Community Clinic Partnership Model Community Clinic Insurers Employers Informed Population Strong Community Organizations Healthy Public Policy } Supportive Environments Screening for High Risk Partnership Zone Reimbursement Lifestyle Weight Control Programs Regular Glucose Monitoring Proactive Practice Team Diagnosis of Pre-diabetes Decision Support Information Systems Informed, Activated Patients Total Population Pre-diabetes Diabetes Complications Control and Primary Prevention Sustain and build on gains in control Gain new resources for primary prevention

11 POLICY DISTRIBUTION POLICY AVAILABILITY POLICY EFFECTIVENESS EFFICIENCY Supply Diffusion of interventions BASIC SCIENCE Molecular/ physiological EFFICACY Ideal settings Biggest effect on most people Real world settings Conducting Translational Research: TRANSLATING RESEARCH INTO ACTION FOR DIABETES (TRIAD) Pacific Health Research Institute Kaiser Permanente No. California UCLA U. Michigan Indiana U. PacifiCare Texas UMDNJ NIDDK CDC Translational Research Centers / TRIAD Study Sites Centers for Disease Control - Sponsor Veterans Health Administration / TRIAD Study Sites National Institute of Digestive and Diabetes and Kidney Disorders

12 Implementing State and National Programs Washington DC Primary Prevention Pilots Tribal Grantees United States Territories American Samoa Federated States of Micronesia Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Virgin Islands National Diabetes Education Program The Association of American Indian Physicians Black Women's Health Imperative Khmer Health Advocates National Alliance for Hispanic Health National Association of School Nurses National Latina Health Network National Medical Association Papa Ola Lokahi. Implementing National Program Initiatives: National Diabetes Education Program* *NDEP is a joint initiative of CDC and NIH

13 Vision World free of the devastation of diabetes