Important Facts for Diabetes Prevalence
DefinitionPercentage of Utah adults diagnosed with diabetes.
NumeratorNumber of Utah adults who reported being told by a health care professional that they have diabetes (excludes women who were told they had diabetes only during pregnancy or those who reported they had "borderline" or pre-diabetes).
DenominatorUtah adults 18 and over.
Data Interpretation IssuesThe Behavioral Risk Factor Surveillance System (BRFSS) is the primary source for estimating diabetes prevalence for Utah and the U.S. The BRFSS is a telephone survey that includes only adults 18 and over.
Why Is This Important?Diabetes has reached epidemic proportions in the U.S. About 25.8 million Americans (8.3% of the U.S. population) have diabetes. However, data from the National Health and Nutrition Survey indicate that about one-fourth to one-third of people with diabetes (over 7 million Americans) have diabetes but don't know they have it and are not yet diagnosed. Another 79 million have pre-diabetes, a condtion that puts them at high risk for developing diabetes unless steps are taken to prevent it. In Utah, approximately 45,000 people have diabetes but are not yet diagnosed.
Diabetes is a disease that can have devastating consequences. It is the leading cause of non-traumatic lower-extremity amputation and renal failure. It is also the leading cause of blindness among adults younger than 75. It is one of the leading causes of heart disease.
Diabetes places an enormous burden on health care resources, approximately $174 billion annually ($116 billion in direct medical costs and $58 billion in indirect costs such as disability, work loss, and premature mortality). (See American Diabetes Association, http://care.diabetesjournals.org/content/31/3/596.abstract). If undiagnosed diabetes, prediabetes, and gestational diabetes were considered in the cost, the total would be closer to $218 billion. In Utah, more than a billion dollars each year are spent on direct and indirect costs of diabetes.
A model using simulated data projected that diabetes incidence will increase from the current rate of 8 cases per 1,000 population to about 15 in 2050. Prevalence of diabetes (including undiagnosed cases) can be as high as one of three Americans by 2050.
Healthy People Objective D-1:Reduce the annual number of new cases of diagnosed diabetes in the population
U.S. Target: 7.2 new cases per 1,000 population aged 18 to 84 years
State Target: 7.2 new cases per 1,000 population aged 18 to 84 years
Other ObjectivesThe Council of State and Territorial Epidemiologists (CSTE) notes that the burden of diabetes in the United States has increased with the increasing prevalence of obesity. Multiple long-term complications of diabetes can be prevented through improved patient education and self-management, and provision of adequate and timely screening services, and medical care.
The new Healthy People 2020 Objective has moved from reducing prevalence of diabetes to reducing incidence. HP 2020 Objective D-1 is "Reduce the annual number of new cases of diagnosed diabetes in the population." The change in focus to reducing incidence makes sense, as the more cases of diabetes are being detected.
How Are We Doing?The prevalence of diabetes has risen steadily, both nationally and in Utah. Several factors contribute to the continual climb in diabetes prevalence. Increasing rates of obesity and sedentary lifestyles add to the number of people at risk for developing diabetes, while improvements in medical care mean people with diabetes are living longer. The 1997 change in the key diagnostic criterion (fasting blood glucose <126 mg/dL) contributed to the increased number of people who were clinically diagnosed. Finally, the proportion of undiagnosed diabetes cases has declined substantially in the past decade. However, the number of undiagnosed individuals is still estimated to be 7 million, nearly 30% of the total diabetes population.
How Do We Compare With U.S.?The percentage of adults with diabetes in Utah is lower than that for the U.S.
An estimated total of nearly 25.8 million people in the U.S. have diabetes (8.3% of the population). Of these, 18.8 million people are diagnosed, and about 7 million are undiagnosed. An estimated 79 million American have pre-diabetes, a condition in which blood sugar is elevated but not high enough to meet the clinical definition of diabetes. In Utah, about 128,000 adults have been diagnosed, while an estimated 45,000 Utah adults have diabetes but don't know they have it.
The Behavioral Risk Factor Surveillance System (BRFSS) database, with information on adults 18 and over, is frequently used to compare U.S. and Utah rates. In Utah, the age-adjusted rate of adults diagnosed with diabetes (standardized to the U.S. 2000 population) was 7.5% (7.2-7.9%) for 2010 (average of 2009-2011). For the U.S. the age-adjusted prevalence was 8.5% (8.4-8.7%) (U.S. BRFSS 2009).
What Is Being Done?The Utah Diabetes Prevention and Control Program (DPCP) works to increase public awareness of the warning signs, symptoms, and risk factors for developing diabetes. The program seeks innovative ways to encourage people at risk to recognize that they may be at risk and need to be tested. The program is promoting A1C awareness among people already diagnosed with diabetes and has produced television and radio public service announcements stressing the urgency of getting A1C levels under control. The program also developed a brochure, "Wish You Could Reverse Time?" to complement its public service announcements. The DPCP, in conjunction with the Utah Health Plan Partnership, has also developed magnets to remind Utahns with diabetes of the importance of managing their ABCs (A1C, blood pressure, and cholesterol levels). The Program also assists community-based organizations as they work to increase awareness of diabetes and its risk factors among members of their populations.
Most recently, the DPCP initiated a program, Faces of Diabetes, that allows individuals to post their personal experiences with diabetes online. This resource allows viewers to learn about diabetes management and challenges by listening to others' stories.
The Arthritis Program supports Chronic Disease Self-Management Programs throughout the state. (This program is also called the Living Well with Chronic Conditions Program.) This six-week program is usually available at no cost and taught by community members. Information is available from Rebecca Castleton, 801-538-9340, firstname.lastname@example.org.
Other Program InformationPackets of information about diabetes, including a brochure describing A1C exams, are available from the Check-Your-Health helpline, 1-888-222-2542. The program website, www.health.utah.gov/diabetes, lists the contact information for diabetes education programs throughout the state.
Anyone is welcome to submit questions about diabetes management online through a unique resource supported by the DPCP, Ask Ginny. Questions are answered at no charge by a team of certified diabetes educators and other experts in the field. The link is available at http://health.utah.gov/diabetes/askginny/index.html.