Diabetes Health Status Report
______Site Name_________
Health Outcomes and Care Given to
Patients with Diabetes
Information from the
Annual Indian Health
Service Diabetes Audit
Source: Site Name and Year IHS Diabetes Audit
Makah couple
Gender Distribution
of
Patients with Diabetes Included in Report
Female
0%
Male
0%
Source: Site Name and Year IHS Diabetes Audit
Age Distribution of Patients with Diabetes
100
Age is a risk factor
for Type 2 Diabetes.
Type 2 Diabetes was
diagnosed
predominately in
patients age 40 and
older.
80
60
%
40
20
0
<15 years
15-44 years
45-64 years
% of patients
Source: Site Name and Year IHS Diabetes Audit
65 years and
older
Today, young adults
(30-35) are the
fastest growing
group of Type 2
Diabetes.
Type of Diabetes Diagnosed
100
80
60
%
40
20
0
Type 1
Type 2
Gestational
% of patients
Source: Site Name and Year IHS Diabetes Audit
IGT
Unknow n
Type 1 Diabetes- Immunemediated form of diabetes.
The body produces no
insulin at all due to islet cell
destruction.
Type 2 Diabetes-Caused by a
combination of insulin
resistance and insulin
deficiency.
Gestational DiabetesDiabetes associated with
pregnancy.
Pre-Diabetes (also called
Impaired Glucose
Tolerance (IGT)-Prediabetic state marked by
elevated blood sugar.
People with IGT are at high
risk for progression to Type
2 Diabetes.
Duration of Diabetes
100
The duration of
diabetes is related
to complications
such as kidney
disease, cardio
vascular disease,
and amputation.
80
60
%
40
20
0
Diabetes can be
effectively treated
and controlled.
Less than 10
years
10 years or more
% of patients
Source: Site Name and Year IHS Diabetes Audit
Diagnosis date
not recorded
Intensive treatment
can reduce the risk
of complications of
diabetes.
Weight Control of Patients with Diabetes
Obesity and physical
inactivity are associated
with the development of
Type 2 Diabetes.
100
Adopting habits that control
weight and increasing
exercise has been shown
to significantly reduce the
risk of developing diabetes.
80
%
60
40
20
0
Overweight or Obese
Obese (BMI>95%ile)
(BMI >85%ile)
BMI not calculated
% of patients
Source: Site Name and Year IHS Diabetes Audit
Minimal weight loss of just
10-20 pounds can improve
blood glucose, blood
pressure, and cholesterol in
patients with Type 2
Diabetes.
As a patient's
Hemoglobin A1c
(A1c) becomes
elevated, the risk
of complications
increases.
Blood Sugar Control
100
80
A1c estimates the
average degree of
glycemic control
over a period of
time.
60
%
40
20
0
HbA1cC HbA1c
<7
7.0-7.9
HbA1c
8.0-8.9
HbA1c
9.0-9.9
% of patients
Source: Site Name and Year IHS Diabetes Audit
HbA1c
10.010.9
HbA1c
>11.0
Undocu
mented
A1c should be
monitored at 3-4
month intervals for
those with
elevated levels
(HbA1C >7.0%).
Blood Pressure Control
100
80
%
60
40
20
0
Ideal BP
Control
(<120/80)
Target
(120/80<130/<85)
Adequate
(130/85<140/<90)
% of patients
Source: Site Name and Year IHS Diabetes Audit
Inadequate
Markedly
BP control
(140/90 - Poor (160/95 undetermine
<160/<95)
or higher)
d
The target Blood
Pressure (BP) for
patients with
diabetes is
< 130/85.
High BP
increases the risk
of heart disease
and renal failure
in Type 2
Diabetes.
Tobacco Use
Tobacco abuse is
the primary
preventable risk
for cardiovascular
disease, which is
the leading cause
of death in
diabetes.
100
80
60
%
40
20
0
Current Tobacco
User
Not a current tobacco
user
% of Patients
Source: Site Name and Year IHS Diabetes Audit
Tobacco use not
documented
Tobacco Counseling for Current Tobacco Users
Over time,
smoking
damages the
blood vessels.
100
80
When coupled
with excessive
glucose in the
blood, the
effect can be
devastating.
60
%
40
20
0
Counseled - Yes
% of smokers
Source: Site Name and Year IHS Diabetes Audit
Counseled - No
Diabetes Treatment
Refused or Undeterm ined
Com bination of Oral Meds + Insulin
Com bination of Oral Meds
Troglitazone
Acarbose
Metform in
Sulfonylurea
Insulin
Diet and Exercise Alone or Undocum ented
0
20
40
60
% of patients
Source: Site Name and Year IHS Diabetes Audit
80
100
Chronic Aspirin Therapy
100
80
60
Aspirin is used as
a primary and
secondary
treatment strategy
to prevent
cardiovascular
events, regardless
of disease status.
%
40
20
0
Yes
No
% of patients
Source: Site Name and Year IHS Diabetes Audit
Undetermined
Men and women
with diabetes have
a 2-4 fold increase
at risk of dying
from complications
of cardiovascular
disease.
ACE Inhibitor Use
100
Treatment with ACE
Inhibitors have been
shown to delay the
progression from
Microalbuminuria to
Proteinuria in patients
with diabetes.
80
60
%
40
20
0
ACE Inhibitors are
medications that
prevent kidney damage
and are prescribed to
patients with diabetes.
Use in pts with overt
proteinuria
Use in pts with known
hypertension
% of patients
Source: Site Name and Year IHS Diabetes Audit
Ace Inhibitors are
commonly prescribed
to patients with
hypertension as well.
Lipid Lowering Agent Use
Optimal LDL cholesterol
levels for adults with
diabetes are <100 mg/dl.
1
Pharmacological intervention is recommended if
dietary and lifestyle
changes are ineffective in
lowering LDL to <100
mg/dl, or immediately if
LDL >160 mg/dl
1
%
1
0
0
0
Use in pts Use in pts
*Statin
*Non-statin
*Statin
w ith total w ith LDL
drug
drug
AND nonchol >=240 chol > 130 prescribed prescribed
statin
% of patients
Source: Site Name and Year IHS Diabetes Audit
People with diabetes
may benefit significantly
from statin therapy even if
their LDL is below
100mg/dl.
Screening for foot
problems, vision
problems, and
dental problems
occur more
frequently for
patients with
diabetes.
Yearly Exams
100
80
60
% Recieving
Exams
40
20
0
Foot Exam Neuro & Vasc
Eye Exam Dilated
Dental Exam
Source: Site Name and Year IHS Diabetes Audit
Pap Smear
(Females
Only)
Diabetics patients
need these exams
at least once a
year.
Type of Education
Diabetes Related Education - Yearly
Medical nutrition,
therapy, and exercise
are the primary
treatment strategies
for Type 2 Diabetes.
Any of the above
topics
Other Diabetes
Education
Exercise Instruction
Diet Instruction
0
20
40
60
80
% Receiving Educational Sessions
Source: Site Name and Year IHS Diabetes Audit
100
All patients with
diabetes and their
families should have
diabetes selfmanagement
education every year.
Diabetic patients should
have a flu vaccine and
pneumovax every year.
Immunizations
100
Yearly re-vaccination for
flu is recommended to
provide up-to-date
protection.
80
60
%
40
20
0
Flu Vaccine - yearly Pneunovax - once
% of patients
Source: Site Name and Year IHS Diabetes Audit
Tetanus/Diphtheria
(q 10 yrs)
The pneumovax
vaccine is necessary at
least once and may
need a booster,
according to physician
discretion.
Analysis of Proteinurea
Protein
appearing in
the urine is an
indication of
kidney
disease.
100
% 50
0
URINALYSIS
Proteinurea
% of patients
Source: Site Name and Year IHS Diabetes Audit
Proteinurea Proteinurea not
Microalbuminuria Analysis
of those Without Protienurea
100
% 50
0
Microalbuminurea Microalbuminurea
% of patients
Source: Site Name and Year IHS Diabetes Audit
Microalbuminurea
People with Type
2 Diabetes who
have
Microalbuminuria
are more likely to
have a heart
attack or stroke.
Treatment with
ACE Inhibitors
slows the
deterioration of
kidney function in
diabetes.
Creatinine Obtained In Past 12 Months
100
80
%
60
40
Blood
creatinine is a
measure of
renal function.
Patients with
diabetes are at
risk for renal
disease.
20
0
CREATININE
Unable to
Creatinine >= Creatinine < 2.0
OBTAINED IN
determine
2.0mg/dl
mg/dl
PAST 12
result
%of patients
Source: Site Name and Year IHS Diabetes Audit
Creatinine not
tested/
Unknown
This test is to
be performed
annually.
Total Cholesterol
Risk factors for
Arteriosclerosis
include:
100
80
Total Cholesterol <200
LDL>100
HDL<40 in
HDL<45 in women
TG>200
60
%
40
20
0
TOTAL
Desirable (<200 Borderline (200- High (240 mg/dl
Unable to
CHOLESTERO
mg/dl)
239 ,g/dl)
or more)
determine result
L OBTAINED
%of patients
Source: Site Name and Year IHS Diabetes Audit
A lipid panel should be
performed annually
(TC, LDL, HDL, TG).
All patients with LDL
>100 require
medical nutrition,
therapy, and
lifestyle
modifications.
LDL Cholesterol
100
80
60
%
40
20
0
LDL
LDL <100
CHOLEST
mg/dl
EROL
LDL 100129 mg/dl
LDL 130160 mg/dl
LDL >160
%of patients
Source: Site Name and Year IHS Diabetes Audit
Unable to
determine Not tested
result
Pharmacological
intervention is
recommended if
dietary interventions
and lifestyle
modifications are
ineffective in
lowering LDL to less
than 100.
Triglycerides
Risk factors for
arteriosclerosis
include:
100
Total Cholesterol
<200
LDL>100
HDL<40 in
HDL<45 in women
TG>200
80
60
%
40
20
0
TRIGLYCERIDE
Unable to
S OBTAINED IN TG <150 mg/dl TG 150-199 mg/dl TG 200-400 mg/dl TG >400 mg/dl
determine results
PAST 12
%of patients
Source: Site Name and Year IHS Diabetes Audit
A lipid panel should
be performed
annually (TC, LDL,
HDL, TG).
Risk factors for
Arteriosclerosis
include:
HDL Cholesteral
100
Total Cholesterol <200
LDL>100
HDL<40 in
HDL<45 in women
TG>200
80
%
60
40
20
0
HDL
CHOLESTEROL HDL <35 mg/dl HDL 35-45 mg/dl HDL 46-55 mg/dl
OBTAINED IN
%of patients
Source: Site Name and Year IHS Diabetes Audit
HDL >55
Unable to
determine result
A lipid panel should
be performed
annually (TC, LDL,
HDL, TG).
EKG Status of Patients with Diabetes
100
%
50
0
Performed in
Performed in
% of patients
Source: Site Name and Year IHS Diabetes Audit
Ever performed
A baseline EKG
should be
obtained after
diagnosis of
diabetes. This
should be
repeated every 1-5
years as clinically
indicated. For
those 40 years of
age and above, or
with diabetes
duration of over 10
years, an EKG
every 1-2 years is
recommended.
Tuberculosis Status of Patients with Diabetes
100
%
50
0
PPD +, INH PPD +,
PPD -,
treatment untreated/i placed
PPD -, PPD status
placed unknow n
% of patients
Source: Site Name and Year IHS Diabetes Audit
Patients with
diabetes are at
risk for activation
of latent
Tuberculosis (TB)
Infection (LBTI).
There is a greater
risk of progressing
to active TB if not
treated.
Patients with
diabetes should
have a PPD if their
TB status is
unknown.
0%
Self Monitoring of Blood Glucose
0%
0%
Yes
No
Self Monitoring
Blood Glucose
(SMBG)
determines the
pattern of blood
glucose
throughout the
day.
Refused
This pattern
provides
information for
selection and
adjustments in
therapy.
Source: Site Name and Year IHS Diabetes Audit