Definition

Diabetes as the underlying cause of death refers to the first-listed cause of death with ICD-10 codes E10-E14 (diabetes mellitus).

Numerator

Number of deaths with diabetes as the underlying cause of death.

Denominator

Number of Utah residents.

Why Is This Important?

Diabetes is a leading cause of disability and death. It is currently the eighth leading cause of death in the U.S.

Healthy People Objective D-2.1:

(Developmental) Reduce the rate of all-cause mortality among the population with diabetes
U.S. Target: Developmental

How Are We Doing?

Utah death rates from diabetes were in decline from 1999 to 2008. From 2009 to 2017, death rates from diabetes remained relatively the same. However, since 2018 the death rates have been increasing slightly.

How Do We Compare With the U.S.?

Between 1999 and 2008, rates for diabetes deaths in Utah were consistently higher than those for the U.S. However, since 2008, Utah had similar death rates for diabetes compared to the U.S. But, in 2020, rates of diabetes deaths in Utah again were higher than those for the U.S. Age-adjusted rates are used in this indicator to account for the differences in age composition between the U.S. and Utah. In 2020, in the U.S., the age-adjusted rate was 24.8 per 100,000 population. For Utah in 2020 the rate was 27.3. In 2020, diabetes was listed as the underlying cause for 778 deaths in Utah.

What Is Being Done?

Diabetes care and education specialists play a prominent role in providing information about nutrition, exercise, and blood glucose monitoring. Diabetes education for all people with diabetes is encouraged to prevent complications and death from diabetes. The Healthy Environments Active Living ([https://heal.health.utah.gov/ HEAL]) Program promotes diabetes education throughout the state. The HEAL program is working statewide to increase the number of locations that offer DSMES and also promote DSMES to eligible participants. The National Diabetes Prevention Program (National DPP) is also an evidence-based program to prevent type 2 diabetes, which would also contribute to reduced deaths from diabetes. The HEAL program works with statewide partners to promote the National DPP to eligible Utahns and also is working to expand National DPP sites across the state.

Evidence-based Practices

Diabetes Self-Management Education and Support ([https://www.cdc.gov/diabetes/managing/education.html DSMES]) has been shown to improve blood glucose control in people with diabetes. Education programs may be recognized/accredited by the American Diabetes Association or the Association of Diabetes Care and Education Specialists. A list of DSMES programs available in Utah is available at https://heal.health.utah.gov/dsmes-programs/.

Available Services

The [https://dhhs.utah.gov/ Utah Department of Health and Human Services] has a Health Resource hotline: 1-888- 222-2542. Please call this number or 211 for information about self-management programs in Utah. The Healthy Environments Active Living ([https://heal.health.utah.gov/ HEAL]) website provides information on diabetes self-management classes. [https://diabetes.org/ American Diabetes Association] 888-DIABETES [https://www.diabeteseducator.org/ Association of Diabetes Care & Education Specialists] 800-338-3633 [https://www.heart.org/ American Heart Association] 1937 S. 300 W. #120 Salt Lake City, UT 84115 (801) 484-3838 or 1-800-242-8721 Also see a list of [https://heal.health.utah.gov/dsmes-programs/ diabetes education classes in Utah], and a [https://heal.health.utah.gov/compass/#/?distance=30&programId=group_2 list of diabetes prevention classes in Utah].

Health Program Information

Staff from the HEAL Program work with health care providers, including diabetes educators, dietitians, pharmacists, community health centers, community health workers, work-sites, and health plans to improve the care provided to Utahns with diabetes. The Utah Department of Health and Human Services, Healthy Environments Active Living program plays a key role in improving the health of residents in the state of Utah. The program was formed in July 2013 (as EPICC), through a new funding opportunity from the Centers of Disease Control and Prevention (CDC) that allowed for the merging of three previously existing programs: the Heart Disease and Stroke Prevention Program, the Diabetes Prevention and Control Program, and the Physical Activity, Nutrition and Obesity Program, as well as the addition of a school health program. The Healthy Environments Active Living Program (HEAL) was recently restructured as part of this strategic planning process and the new program model focuses on working together with staff and partners to address the social determinants of health while advancing health equity and increasing policy, systems and environment changes. HEAL champions public health initiatives and addresses the challenges of making health awareness and access truly universal and equitable in eight key areas: nutrition, heart health, diabetes, physical activity, schools, child care, community health workers, and worksites. Visit [https://heal.health.utah.gov/ HEAL?s website] for more information.

Relevant Population Characteristics

In 2020, diabetes was the eighth leading cause of death in Utah. People of minority races (particularly American Indian and Pacific Islander) had an increased risk of dying from diabetes.

Health Care System Factors

Regular check-ups and laboratory exams are essential for detecting early signs of complications. With adequate preventive care and regular routine physician visits, some diabetes deaths could be prevented. Many diabetes- related problems, such as hypertension (high blood pressure) and early end-stage renal (kidney) disease, go undetected and are diagnosed only after serious complications have developed. This issue is particularly pronounced among people without insurance who often do not have the resources to seek regular, routine care for their diabetes.

Risk Factors

Risk factors for diabetes include age, obesity, sedentary lifestyle, family history, hypertension, and dyslipidemia (including high blood cholesterol or triglycerides). The more risk factors a person has, the greater his or her chance of developing diabetes. Prediabetes is a condition in which a person's blood sugar levels are elevated but not quite high enough to meet the clinical threshold for diabetes. Unless steps are taken, most people with prediabetes will develop type 2 diabetes. Having had gestational diabetes during pregnancy is also a risk factor for developing type 2 diabetes.

Health Status Outcomes

Uncontrolled diabetes can lead to debilitating health problems. People with diabetes have an excess risk for kidney failure, blindness, non- traumatic lower extremity amputations, and neuropathy (nerve damage). People with diabetes are more likely to report their health as "fair" or "poor" than people without diabetes.

The estimates for the local health districts use four years of combined data so that reliable estimates could be obtained. There was considerable variation in age-adjusted death rates by local health districts. Tooele, Central, and San Juan had the highest rates.

Data Notes

Age-adjusted to the 2000 U.S. standard population using 11 age groups.

Data Source

Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health

Because the number of deaths from diabetes within each small area is relatively small, this chart uses seven years of death data to obtain reliable death rates. Still, a number of small areas (11) have estimates that do not meet DHHS standards for reliability.

Data Notes

Age-adjusted to the 2000 U.S. standard population using 11 age groups. *Unreliable Estimates: Use caution in interpreting; the estimate has a coefficient of variation >30% and is therefore deemed unreliable by Utah Department of Health standards. A description of the Utah Small Areas may be found on the [https://ibis.health.utah.gov/resource/Guidelines.html Methodology and Guidelines page].

Data Source

Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health

Diabetes death rates in Utah, in general, exceed U.S. diabetes death rates. Utah death rates from diabetes were in decline from 1999 to 2008. From 2009 to 2017 death rates from diabetes remained fairly constant. However, since 2018 the death rates have been increasing slightly in Utah.

Data Notes

Age-adjusted to the 2000 U.S. standard population using 11 age groups.

Pacific Islander Utahns had exceptionally high death rates due to diabetes.

Data Notes

All races may be of Hispanic/Latino or non-Hispanic/Latino ethnicity.[[br]] Data shown are for 2020-2021 (combined years) and age-adjusted to the 2000 U.S. standard population using 3 age groups.

Data Source

Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health

The diabetes death rate is statistically similar among Hispanics, Non- Hispanics, and all adult Utahns.

Data Notes

Age-adjusted to the 2000 U.S. population using 11 age groups.

Data Source

Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health

References and Community Resources

[https://diabetes.org/ American Diabetes Association] [https://www.cdc.gov/diabetes/index.html Division of Diabetes Translation], Centers for Disease Control and Prevention [https://wonder.cdc.gov/ CDC Wonder] Association of Diabetes Care & Education Specialists http://www.diabeteseducator.org