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June, 2007


Highlights in Minority Health
November, 2004

November 2004, Diabetes Awareness Month

NOVEMBER IS DIABETES AWARENESS MONTH!
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both1. If not treated, diabetes can lead to serious problems. Diabetes can affect the eyes, kidneys, nerves, gums, teeth, and blood vessels. Diabetes is the leading cause of adult blindness, lower limb amputations, and kidney failure. It can cause heart disease and stroke, and even death if untreated2.
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Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in the development of this type of diabetes3.
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Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90 to 95 percent of all diagnosed cases of diabetes.  Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity3.
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Gestational diabetes is a form of glucose intolerance that is diagnosed in some women during pregnancy. After pregnancy, 5 percent to 10 percent of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20 percent to 50 percent chance of developing diabetes in the next 5-10 years1.
In 2002, 18.2 million -- 6.3 percent of the population in the United States -- had diabetes: 13.0 million people had diagnosed diabetes and 5.2 million people had undiagnosed diabetes. Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2000. This ranking is based on the 69,301 death certificates in which diabetes was listed as the underlying cause of death. Altogether, diabetes contributed to 213,062 deaths1. About 40 percent of U.S. adults ages 40 to 74, or 41 million people, currently have pre-diabetes4, a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes5.
People aged 65 years or older account for almost 40 percent of the population with diabetes6.  However, as obesity rates in children continue to soar, type 2 diabetes, a disease that used to be seen primarily in adults over age 45, is becoming more common in young people. About 150,000 school-aged children and adolescents have diabetes7.
 
EXAMPLES OF HEALTH DISPARITIES RELATED TO DIABETES
 
African Americans
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2.7 million or 11.4 percent of all non-Hispanic blacks aged 20 years or older have diabetes. On average, non-Hispanic blacks are 1.6 times as likely to have diabetes or impaired fasting glucose, a form of pre-diabetes, as non-Hispanic whites of similar age1 (age-adjusted rates in 1999-2000 were black non-Hispanic: 21.1 percent; white non-Hispanic: 13.1 percent)8.
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In 2000, death rates from diabetes were more than twice as high for African Americans (49.2 per 100,000) as for non-Hispanic whites (22.1 per 100,000)9.
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African Americans with diabetes are more likely to develop diabetes complications and experience greater disability from the complications than whites with diabetes10:
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African Americans tend to have a slightly higher prevalence of visual impairment than whites or Hispanics/Latinos. In 2002, the age-adjusted prevalence of visual impairment was 19.7 percent for whites, 20.3 percent for Hispanics/Latinos, and 22.7 percent for African Americans11.
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Kidney failure (end-stage renal disease or ESRD) is about four times more common in African Americans with diabetes than in whites with diabetes4. In 2001, the age-adjusted incidence of ESRD related to diabetes in the diabetic population was 504.30 per 100,000 for African American males (compared to 222.05 per 100,000 for white males) and 356.22 per 100,000 for African American females (compared to 176.36 per 100,000 for white females)12.
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Amputations of lower extremities (legs and feet) are more common in African Americans with diabetes4. In 2001, the age-standardized hospital discharge rate for nontraumatic lower extremity amputation (LEA) rate per 1,000 persons with diabetes was 5.2 among African Americans and 4.4 among whites13.
 
American Indians/Alaska Natives (AI/ANs)
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14.9 percent of AI/ANs aged 20 years or older and receiving care from the Indian Health Service (IHS) have diabetes. This compares with 8.4 percent of the non-Hispanic white population aged 20 years or older1.
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In 2000, death rates from diabetes were almost twice as high for AI/ANs (40.4 per 100,000) as for non-Hispanic whites (22.1 per 100,000)9.
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At the regional level, diabetes is least common among Alaska Natives (8.2 percent) and most common among American Indians in the Southeastern United States (27.8 percent) and southern Arizona (27.8 percent)1For example, 50 percent of Pima Indians in Arizona who are between the ages of 30 and 64 have type 2 diabetes14.
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Compared to 0.25 percent of all people under 20 years of age in the U.S.  who have diabetes1, American Indian youths have the highest prevalence of type 2 diabetes. In the 15-to-19-year age group, the current prevalences were
red triangle 50.9 per 1000 for Pima Indians from Arizona;
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4.5 per 1000 for all U.S. American Indian populations (reported cases from the U.S. Indian Health Service outpatient clinics)15.
 
Asians/Pacific Islanders (APIs)
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6.3 percent of Asian Americans who participated in the National Health Interview Survey (NHIS) 18 years of age and over have diabetes16.  Overall, 6.3 percent of the U.S. population has diabetes, and 8.4 percent of the non-Hispanic whites aged 20 and older have diabetes1.
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In 2000, death rates from diabetes were lowest for AAPIs (16.9 per 100,000) compared with all other races/ethnicities.  The group with the next lowest rates was non-Hispanic whites (22.1 per 100,000)9.
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In 2002, Native Hawaiian residents of Hawaii aged 20 and older were approximately 2 times as likely to have diagnosed diabetes as white residents of Hawaii of similar age1.
 
Hispanics/Latinos
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8.2 percent of all Hispanic/Latino Americans aged 20 years or older have diabetes.  On average, Hispanic/Latino Americans are 1.5 times more likely to have diabetes than non-Hispanic whites of similar age1 (2002 figures are Hispanic/Latino males: 7.5 percent, white males: 5.0 percent; Hispanic/Latino females, 6.3 percent, white females: 4.0 percent)17.
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In 2000, death rates from diabetes were 1.7 times as high for Hispanics/Latinos (36.7 per 100,000) as for non-Hispanic whites (22.1 per 100,000)9.
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About one-third of total diabetes among Hispanic Americans is undiagnosed.  This is similar to the proportion for other racial/ethnic groups in the United States18.
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Mexican Americans, the largest Hispanic/Latino subgroup, are almost twice as likely to have diabetes as non-Hispanic whites of similar age1 (age-adjusted rates are Mexican Americans: 12.0 percent; white non-Hispanic: 7.4 percent)8.
 
PROMISING INTERVENTION STRATEGIES
To reduce the rate of diabetes and its complications among high-risk minority populations:
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Improve care for control of diabetes and treatment of major complications, including eye and foot examinations
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Conduct clinical trials to prevent the onset of type 2 diabetes in individuals at most risk for developing the disease. Minorities are most likely to be affected by type 2 diabetes3.
Because many complications from kidney disease, blindness, and amputations can be prevented, health care providers should take advantage of their patients’ routine office visits to conduct foot and kidney exams, and recommend eye screenings once a year and teach patients to make proper diabetes management a part of their daily lives3.
Reducing high blood pressure among people with diabetes could prevent one-third of diabetes-related eye, kidney, and nerve diseases3.
Approximately 60 percent of diabetes-related blindness could be avoided with good blood glucose control or by early detection and laser treatments3.
About half of all lower-extremity amputations can be prevented by properly caring for feet and by reducing risk factors such as abnormally high blood sugar, cigarette smoking, and high blood pressure3.
 
PROGRAMS
National Diabetes Education Program (NDEP)
The NDEP is a joint initiative sponsored by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). It is based on a partnership of public and private organizations that are concerned about the health status of their constituents. The NDEP is designed to improve treatment and outcomes for people with diabetes, to promote early diagnosis, and to prevent the onset of diabetes. Program activities are directed to these audiences: the general public; people with diabetes and their families; health care providers; and payers and purchasers of health care and policymakers19.
 
National Hispanic/Latino Diabetes Initiative for Action (NH/LDIA)
NH/LDIA was created in 1995 by CDC to serve as a blueprint for CDC to frame interdisciplinary, culturally relevant approaches to control diabetes and its complications in the U.S. Hispanic/Latino community.  Because it is also a long-range "road map," the initiative is comprehensive in scope20.
 
Racial and Ethnic Health Disparities Initiatives (REACH 2010)
REACH 2010 is part of the national initiative to eliminate disparities in health status experienced by racial and ethnic minority populations in six priority areas, including diabetes.  REACH 2010 supports community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities.  Each coalition comprises a community-based organization and three other organizations, of which at least one is either a local or state health department or a university or research organization.  The activities of these community coalitions include continuing education on disease prevention for health care providers, health education and health promotion programs that use lay health workers to reach community members, and health communications campaigns21.
 
United States and Mexico Border Diabetes Prevention and Control Project
The US/Mexico Border Diabetes Prevention and Control Project involves four United States and six Mexican states along the border. State-based diabetes prevention and control programs are collaborating with the Mexican states and the Mexico Department of Health Ministry to devise and implement strategies to reduce the burden of diabetes among people who live along the border. Diabetes program representatives for all 10 U.S. and Mexican states met in August 1998 in Juarez, Mexico, to agree on the protocols to conduct a household diabetes surveillance study along the U.S./Mexico border. The group held three other meetings, and many conference calls, to draft a proposal to request funding from the CDC, the Office of Minority Health, the Office of International and Refugee Health, and the Pan American Health Organization (PAHO) (through the U.S./Mexico Border Health Association)22.
 
Diabetes Intervention Reaching and Educating Communities Together (Project Direct)
Project DIRECT is a multiyear community diabetes demonstration project, funded primarily by the CDC.  It is intended to develop, implement, and evaluate strategies that can be incorporated into state-based diabetes prevention and control programs nationwide. DIRECT focuses on an African-American community in southeast Raleigh, NC.  The three main intervention components are health promotion, outreach, and diabetes care23.
 
FOR MORE INFORMATION
Centers for Disease Control and Prevention (CDC)
  Office of Minority Health (OMH)
    Eliminate Disparities in Diabetes
    2003 Diabetes Highlight
  CDC Health Topic: Diabetes
  National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)
    CDC Diabetes Public Health Resource
      Data & Trends
      National Diabetes Education Program National Minority Organizations
      National Diabetes Fact Sheet
    Division of Nutrition and Physical Activity
  White House Presidential Proclamation
  Food and Drug Administration (FDA)
    Diabetes Information
    National Diabetes Fact Sheet
  Indian Health Service (IHS)
    Division of Diabetes Treatment and Prevention
  Medline Plus: Diabetes
  National Diabetes Education Program (NDEP)
  National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
    Conquering Diabetes: A Strategic Plan for the 21st Century
    Diabetes in Select US Populations
    National Diabetes Information Clearinghouse
  National Institute of Child Health and Human Development (NICHD)
    Are You At Risk for Gestational Diabetes?
  American Diabetes Association

 

SOURCES
  1. Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), “National Diabetes Fact Sheet, United States, 2003”
  2. National Diabetes Education Program (NDEP), “Diabetes in Children and Adolescents Fact Sheet”
  3. CDC’s Office of Minority Health (OMH), “Eliminate Disparities in Diabetes,” 2004
  4. US Dept. of Health and Human Services (HHS), Office of Minority Health Resource Center (OMHRC) “Diabetes,” 2004
  5. National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), National Diabetes Information Clearinghouse (NDIC), “National Diabetes Statistics,” 2004
  6. CDC, NCCDPHP, Diabetes Public Health Resource (DPHR), “Diabetes Surveillance System: Prevalence of Diabetes,” 2004     Figure               Table
  7. NDEP, “Resources on Children and Adolescents”
  8. CDC, Morbidity and Mortality Weekly Report (MMWR) “Prevalence of Diabetes and Impaired Fasting Glucose in Adults, 1999-2000,” 2003, 52(35): 833-837
  9. CDC, National Center for Health Statistics (NCHS), Health US, 2003, table 29
  10. NDIC, “Diabetes in African Americans,” 2002
  11. NCCDPHP, DPHR, “Diabetes Surveillance System: Vision Impairment,” 2004 
Figure   Table
  12. NCCDPHP, DPHR, “Diabetes Surveillance System: End-Stage Renal Disease,” 2004 
Figure   Table
  13. NCCDPHP, DPHR, “Diabetes Surveillance System: Nontraumatic Lower Extremity Amputation with Diabetes,” 2004 
Figure   Table
  14. The National Women’s Health Information Center (NWHIC), “Health Problems in American Indian/Alaska Native Women: Diabetes,” 2003
  15. CDC, NCCDPHP, DPHR, “Diabetes Projects,” 2004
  16. CDC, NCHS, “Summary Health Statistics for U.S. Adults: National Health Interview Survey (NHIS), 2002,” Vital and Health Statistics 10(22): 30-31
  17. CDC, NCCDPHP, DPHR, “Diabetes Surveillance System: Prevalence of Diabetes,” 2002
  18 NIDDK, “Diabetes in Hispanic Americans,” 2002
  19. NCCDPHP, DPHR, “About CDC's Division of Diabetes Translation”
  20. NCCDPHP, DPHR, “Diabetes Projects: National Hispanic/Latino Diabetes Initiative for Action,” 2004
  21. CDC, Racial and Ethnic Approaches to Community Health (REACH 2010), “Goals for 2010,” 2004
  22. NCCDPHP, DPHR, “Diabetes Projects: US/Mexico Border Diabetes Prevention and Control Project,” 2004
  23. NCCDPHP, DPHR, “Diabetes Projects: Project DIRECT,” 2004
     

 

 

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