The Diabetes Problem
What the new statistics tell us and
implications for the future
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.
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
www.cdc.gov/diabetes
Household
Surveys
Hospitals
CDC
National Diabetes Surveillance System
Vital statistics
Registries
Telephone
Surveys
Diabetes Fact Sheet, 2011
Citation: Centers for Disease Control and Prevention, National diabetes fact sheet: national estimates and general
information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, 2011.
http://www.cdc.gov/diabetes/pubs/factsheet11.htm
www.cdc.gov/diabetes
26 million
with Diabetes
79 million
with Prediabetes
Latest Diabetes Prevalence Data
 25.8 million people in the U.S. have diabetes
• 17.8 million are diagnosed
• 8.0 million are undiagnosed
• 11.3% of those >20 years old
• 26.9% of those >65 years old
 79 million people in the U.S. have
prediabetes
Source: Diabetes Fact Sheet, 2011
http://www.cdc.gov/diabetes/pubs/factsheet11.htm
www.cdc.gov/diabetes
Latest diabetes prevalence data
www.cdc.gov/diabetes
Age-Adjusted Percentage of U.S. Adults with
Diagnosed Diabetes or Obesity
Diabetes Prevalence
1994
2000
No Data
<4.5%
4.5-5.9%
6.0-7.4%
2009
7.5-8.9%
>9.0%
Obesity (BMI ≥30 kg/m2)
1994
No Data
<14.0%
www.cdc.gov/diabetes
2000
14.0-17.9%
18.0-21.9%
2009
22.0-25.9%
>26.0%
County-Level Estimates of Diagnosed Diabetes
Among US Adults Aged ≥20 Years: 2004–2008
www.cdc.gov/diabetes
County-Level Estimates of Obesity
Among US Adults Aged ≥20 Years: 2004–2008
www.cdc.gov/diabetes
County-Level Est. of Leisure-Time Physical Inactivity
Among US Adults Aged ≥20 Years: 2004–2008
www.cdc.gov/diabetes
County-Level Diabetes, Obesity, LeisureTime Physical Inactivity: Key Trend
• Counties with high levels of all three are primarily
concentrated in the South and Appalachia
• Counties with low levels of all three are primarily
concentrated in the West and Northeast
www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Diabetes rates by race and ethnicity
7.1% of non-Hispanic whites >20 years old have
diabetes
Rate is 18% higher for Asian Americans >20 years old
Rate is 66% higher for Hispanics >20 years old overall
• Similar to non-Hispanic whites for Cubans and Central and
South Americans
• 87% higher for Mexican Americans
• 94% higher for Puerto Ricans
www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Diabetes rates by race and ethnicity
Rate is 77% higher for non-Hispanic blacks >20
years old
16.1% of the adult population served by Indian
Health Service has diagnosed diabetes
• 5.5% among Alaska Native adults
• 33.5% among American Indian adults in
southern Arizona
www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Diabetes rates by race and ethnicity
Non-Hispanic whites
Asian Americans
Hispanics (overall)
www.cdc.gov/diabetes
Non-Hispanic blacks
Alaska Natives/American Indians (overall)
Diabetes Fact Sheet, 2011
Diabetes rates by race and ethnicity
Non-Hispanic whites
Non-Hispanic blacks
Asian Americans
Alaska Natives/American Indians (overall)
Hispanics (overall)
Specific AN/AI groups
Specific Hispanic groups
www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Gestational diabetes
 2%–10% of pregnant women will
develop gestational diabetes
• Likely rate will be higher when using new
diagnostic criteria
 Women are much more likely to get
type 2 diabetes later if they have
gestational diabetes
• 5%–10% immediately after pregnancy
• 35%–60% within 10–20 years
http://www.cdc.gov/diabetes/pubs/factsheet11.htm
www.cdc.gov/diabetes
Burden of Diabetes in Youth
Applied to US Census data, we estimate that
 In 2001: 154,000 US youth had physician-dx diabetes
 15,000 youth are diagnosed annually with T1 diabetes
 3600 youth are diagnosed annually with T2 diabetes
www.cdc.gov/diabetes
Prevalence of DM in Youth
0-9 Years
10-19 Years
Source: Pediatrics 2006; based on 6379 cases, from surveillance denominator of 3,499,846
www.cdc.gov/diabetes
Annual Incidence per 100,000 people
by Race/Ethnicity & Clinical DM Type
Source: SEARCH for Diabetes in Youth Study (2002-2005 data)
www.cdc.gov/diabetes
Beyond Type:
Characteristics of Youth with Diabetes
Type 1
www.cdc.gov/diabetes
Type 2
What about Overweight and Obesity?
Type 1
www.cdc.gov/diabetes
Type 2
Prevalence of Selected Health Behaviors
Type 1
www.cdc.gov/diabetes
Type 2
Minority Youth with Poor Glycemic Control
Race/Ethnicity
Type 1 (%)
Type 2 (%)
Non-Hispanic White
12.3
12.2
African-American
35.5
22.3
Hispanic
27.3
27.4
Asian / Pacific Islander
26.0
36.4
Native American
52.2
43.8
www.cdc.gov/diabetes
Incidence of diagnosed diabetes (1980–2007)
and projected incidence (2008–2050)
Source: http: //www.pophealthmetrics.com/content/8/1/29
www.cdc.gov/diabetes
Number of People with Diabetes (20-79 years),
2010 and 2030
Diabetes Fact Sheet, 2011
Health burden
 The 7th leading cause of death in the U.S.
• Underlying cause on 71,382 death certificates
• Contributing cause on 231,404 death certificates
 The leading cause of kidney disease
 The leading cause of nontraumatic lower-limb
amputations
 The leading cause of new cases of blindness
 Significant contributor to heart disease and stroke
www.cdc.gov/diabetes
http://www.cdc.gov/diabetes/pubs/factsheet11.htm
Diabetes Fact Sheet, 2011
Health burden
 Heart disease and stroke
• 2 to 4 times more likely in people with diabetes
 Hypertension
• 67% of adults with diabetes have hypertension
 Eye Problems
• 28.5% of people with diabetes >40 years old had
diabetic retinopathy
 Kidney disease
• Over 200,000 people with diabetes-related ESRD on
chronic dialysis or had a transplant (2008)
www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Health burden
 Nervous system disease
• 60% to 70% of people with diabetes >40 years old have
mild to severe nervous system damage
 Other examples of possible health complications
• Dental disease
• Pregnancy complications
• Greater susceptibility to diseases such as influenza and
pneumonia
• Depression
www.cdc.gov/diabetes
Death rates (age adjusted) with hyperglycemic crises as
underlying cause per 100,000 with diabetes, U.S., 1980–2005
Source: www.cdc.gov/diabetes/statistics/mortalitydka/fRateDKADiabTotals.htm
www.cdc.gov/diabetes
Age-Adjusted Percentage of US Adults with Diabetes
Reporting Visual Impairment, 1997–2009
Source: www.cdc.gov/diabetes/statistics/visual/fig2.htm
www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Treatment of diabetes: U.S., 2007–2009
www.cdc.gov/diabetes
Diabetes Fact Sheet, 2011
Economic cost of diabetes
Medical expenses for people with diabetes are more
than two times higher than for people without
diabetes
Indirect costs
$ 58 billion
Direct costs
$116 billion
Total
$174 billion
(2007 figures)
http://www.cdc.gov/diabetes/pubs/factsheet11.htm
www.cdc.gov/diabetes
Strategy
Prevent diabetes
Prevent diabetes complications and disabilities
Eliminate diabetes-related health disparities
www.cdc.gov/diabetes
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)
The Community – Clinic Partnership Model
Community
Insurers
Partnership Zone
}
Employers
Informed Population
Strong Community
Organizations
Proactive Practice
Team
Diagnosis of
Prediabetes
Decision Support
and Diabetes
Reimbursement
Screening for
High Risk
Structured Lifestyle
Programs
Healthy Public
Policy
Supportive
Environments
Total Population
Clinic
Information
Systems
Regular
Glucose
Monitoring
Pre-diabetes
Diabetes
Informed,
Activated
Patients
Complications
Summary
• More people have diabetes and more are
developing it
• Future projections underscore prevention is
critical
• Diabetes management remains a priority
• Eliminating disparities is key
• There are effective diabetes prevention and
management interventions that must be
scaled-up and sustained
Resources and Media Contacts
• Division of Diabetes Translation
– www.cdc.gov/diabetes
• National Diabetes Education Program
– www.yourdiabetesinfo.org
• Media Contacts
– Email: media@cdc.gov
– Phone: 404-639-3286