Diabetes: The Epidemic of the 21st Century
A Managed Care Perspective: The Arizona Experience
Roberto Ruiz, M.D., F.A.C.P.
Arizona Demographics
Total Number of Residents
White
Hispanic
American Indian
Black
statehealthfacts.org
6,440,990
58%
31%
8%
4%
Arizona Demographics
Health Insurance Coverage (2007-2008)
Employer
Individual
Medicaid
Medicare
Other Public
Uninsured
Statehealthfacts.org
47.0%
4.7%
16.8%
11.4%
1.2%
18.9%
Arizona Demographics
• Arizona has seen a 44 percent increase in
adults with diabetes from 2000 through 2006
• prevalence rising from 5.9 percent to 8.5.
• In Arizona, 9.2 percent of Hispanics have
diabetes whereas 7.8 percent of nonHispanic Whites have diabetes.
Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition
Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition
Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition
Arizona Demographics
Diabetes Related Discharges
2005
Totals
2008
175,786
209,265
< 15
1,197
1,221
15-19
1,495
1,983
20-44
31,750
39,494
45-64
65,658
80,774
65+
75,685
85,793
Maricopa
97,208
120,578
Arizona Department of Health Services
Hospital Inpatient Discharges
2005
2008
99,111
108,662
55,919
62,076
Arizona Demopgraphics
Emergency Room Visits
2005
2008
76,675
100,603
< 15
722
725
15-19
883
1,210
20-44
19,123
25,320
45-64
29,491
40,288
65+
26,455
33,060
Maricopa
41,289
58,502
Totals
Arizona Department of Health Services
Arizona Demographics
Patient Days for Inpatient Discharges for Diabetes
2005
2008
44,637
47,679
1,095
1,191
15-19
997
1,372
20-44
10,047
11,657
45-64
17,615
19,187
65+
14,883
14,272
Maricopa
22,263
26,567
Totals
< 15
Arizona Department of Health Services
Arizona Demographics
Patient Days for Inpatient Discharges for Diabetes
2005
2008
4,560
4,795
2,420
3,010
Hispanic (4.9)
10,896
12,067
White
24,974
26,431
American Indian
(6.2)
Black or African American (4.5)
(4.8)
Arizona Department of Health Services
National Diabetes - 2007
Prevalence of Impaired Fasting Glucose in People < 20 in U.S.
In 1999 – 2000, 7% had IFG
In 2003 - 2006,
25.9% of Adults 20 yrs. or older had IFG
35.4 % of Adults age 60+ had IFG
Applying this percentage to the entire U.S. population in 2007
yields an estimated 57 million American adults aged 20 yrs. Or
older, suggesting that at least 57 million American adults had
pre-diabetes in 2007
National Diabetes Clearinghouse (NDIC)
National Diabetes - 2007
Prevalence of Diagnosed and Undiagnosed Diabetes in 2007
Total 23.6 Million people
Diagnosed
7.8 % of population have diabetes
17.9 million people
Undiagnosed 5.7 million people
National Diabetes Clearinghouse (NDIC)
National Diabetes - 2007
NHW=Non-Hispanic Whites; AA=African Americans; H=Hispanics;
API=Asians/Pacific Islanders; AI=American Indians
Source: SEARCH for Diabetes in Youth Study.
Complications of Diabetes in the
United States
In 2004, heart disease was noted on 68 percent of diabetes-related
death certificates among people ages 65 years or older.
In 2004, stroke was noted on 16 percent of diabetes-related death
certificates among people ages 65 years or older.
Adults with diabetes have heart disease death rates about two to
four times higher than adults without diabetes.
The risk for stroke is two to four times higher among people with
diabetes.
National Diabetes Clearinghouse (NDIC)
Complications of Diabetes in the
United States
In 2003 to 2004, 75 percent of adults with self-reported diabetes
had blood pressure greater than or equal to 130/80 millimeters of
mercury (mm Hg) or used prescription medications for
hypertension.
Diabetes is the leading cause of new cases of blindness among
adults ages 20 to 74 years.
Diabetic retinopathy causes 12,000 to 24,000 new cases of
blindness each year.
National Diabetes Clearinghouse (NDIC)
Complications of Diabetes in the
United States
Diabetes is the leading cause of kidney failure, accounting for 44
percent of new cases in 2005.
In 2005, 46,739 people with diabetes began treatment for endstage kidney disease in the United States and Puerto Rico.
In 2005, a total of 178,689 people with end-stage kidney disease
due to diabetes were living on chronic dialysis or with a kidney
transplant in the United States and Puerto Rico.
National Diabetes Clearinghouse (NDIC)
Complications of Diabetes in the
United States
About 60 to 70 percent of people with diabetes have mild to severe
forms of nervous system damage. The results of such damage
include impaired sensation or pain in the feet or hands, slowed
digestion of food in the stomach, carpal tunnel syndrome, erectile
dysfunction, or other nerve problems.
Severe forms of diabetic nerve disease are a major contributing
cause of lower-extremity amputations.
National Diabetes Clearinghouse (NDIC)
Complications of Diabetes in the
United States
More than 60 percent of nontraumatic lower-limb amputations
occur in people with diabetes.
In 2004, about 71,000 nontraumatic lower-limb amputations were
performed in people with diabetes.
National Diabetes Clearinghouse (NDIC)
Complications of Diabetes in the
United States
Periodontal, or gum, disease is more common in people with
diabetes. Among young adults, those with diabetes have about
twice the risk of those without diabetes.
People with poorly controlled diabetes—A1C greater than 9
percent—were nearly three times more likely to have severe
periodontitis than those without diabetes.
Almost one-third of people with diabetes have severe
periodontal disease with loss of attachment of the gums to the
teeth measuring 5 millimeters or more.
National Diabetes Clearinghouse (NDIC)
Complications of Diabetes in the
United States
Poorly controlled diabetes before conception and during the first
trimester of pregnancy among women with type 1 diabetes can
cause major birth defects in 5 to 10 percent of pregnancies and
spontaneous abortions in 15 to 20 percent of pregnancies.
Poorly controlled diabetes during the second and third trimesters of
pregnancy can result in excessively large babies, posing a risk to
both mother and child.
National Diabetes Clearinghouse (NDIC)
Complications of Diabetes in the
United States
Uncontrolled diabetes often leads to biochemical imbalances
that can cause acute life-threatening events, such as diabetic
ketoacidosis and hyperosmolar, or nonketotic, coma.
People with diabetes are more susceptible to many other
illnesses and, once they acquire these illnesses, often have
worse prognoses. For example, they are more likely to die with
pneumonia or influenza than people who do not have diabetes.
National Diabetes Clearinghouse (NDIC)
A closer look at my patients……
Southwest Internal Medicine Group
Age Distribution
50
45
40
35
30
25
20
15
10
5
0
%
0-17
18-44
45-64
65+
HbA1c Distribution
50
45
40
35
30
25
20
15
10
5
0
%
Less 6.7-7.0 7.1-8.0 8.1-9.4 9.5 and
than 6.5
above
HbA1c
• Average HbA1c for the Southwest Internal
Medicine Group is 6.4
• Average HbA1c for the Nation is 9.0