Preventive Care Practices

Diabetes-related complications can be serious, costly, and deadly. They include heart disease, stroke, kidney damage (chronic kidney disease and kidney failure), blindness, and amputations of the legs and feet. Diabetes-related complications are more likely and more severe among people whose diabetes is not well managed and those who have had diabetes longer. People with diabetes can better manage their condition and improve their health by following preventive care practices. These practices include receiving annual foot and eye exams and attending diabetes self-management classes. Table 2 presents estimates of the percentage of US adults aged 18 or older with diagnosed diabetes who reported receiving recommended preventive care practices by state.

Table 2. Percentage of US Adults Aged 18 or Older with Diagnosed Diabetes Who Reported Receiving Recommended Preventive Care Practices, by State, 2015

Percentage of US Adults Aged 18 or Older with Diagnosed Diabetes Who Reported Receiving Recommended Preventive Care Practices, by State, 2015
State Two or more A1c Tests in the Last Year Foot Exam
by Health Professional in the Last Year
Ever Attended Diabetes Self-Management Class Dilated Eye Exam in the Last Year Daily Self-Monitoring of Blood Glucose
Alabamaa 69.6 69.7 53.4 60.6 69.2
Alaskab 62.2 76.1 59.0 57.4 68.3
Arizona 66.8 66.0 49.9 61.5 64.1
Arkansasa 53.3 61.4 50.6 57.9 67.4
California 63.9 62.9 64.5 59.7 42.7
Colorado 63.2 67.9 54.4 61.1 55.6
Connecticut 74.8 72.8 47.7 64.6 61.1
Delaware 72.2 78.6 48.5 63.4 59.4
District of Columbia 71.5 79.1 53.0 66.1 72.0
Florida 74.4 52.4 45.2 62.1 62.2
Georgia 63.5 65.2 52.9 65.6 61.3
Hawaii 73.4 74.4 58.4 68.6 51.7
Idaho NAc NA NA NA NA
Illinois 67.9 74.2 61.4 61.5 70.2
Indiana 73.1 70.6 59.2 49.8 64.2
Iowa 78.7 79.3 65.2 64.1 65.9
Kansas 71.4 69.6 59.8 64.6 58.7
Kentucky 74.5 69.3 50.0 61.2 64.5
Louisiana 64.8 62.5 46.1 56.5 56.7
Maineb 77.3 80.8 59.3 60.6 60.7
Maryland 75.4 75.7 59.0 61.9 65.9
Massachusettsa 73.4 72.0 45.8 76.7 70.1
Michigan 65.7 71.6 60.0 62.9 64.3
Minnesota 75.4 81.4 69.1 74.4 64.8
Mississippib 65.1 62.1 45.0 58.9 59.7
Missouria 66.1 57.1 65.9 60.7 61.8
Montanab 72.8 82.7 63.1 56.1 41.6
Nebraska 69.1 66.0 59.5 61.9 59.5
Nevada 69.6 74.1 74.0 65.3 75.9
New Hampshire 80.0 86.4 60.2 66.6 58.4
New Jersey 65.8 61.1 42.7 58.0 60.0
New Mexico 73.6 75.9 48.1 61.2 65.5
New York 77.3 71.5 34.8 67.0 56.1
North Carolina 80.5 77.6 62.5 61.6 73.4
North Dakotab 66.1 82.7 66.8 58.0 65.5
Ohiob 68.1 68.6 63.9 60.0 64.1
Oklahoma 65.0 66.0 51.1 55.1 72.9
Oregona 67.1 73.2 56.1 54.9 57.7
Pennsylvania 73.3 81.0 50.5 69.0 63.7
Rhode Island 80.3 76.8 56.8 60.7 70.9
South Carolina 69.2 63.9 54.1 56.5 62.1
South Dakotab 76.8 68.0 62.9 67.9 53.0
Tennessee 67.2 60.0 48.8 52.6 65.2
Texas 59.7 62.9 59.3 59.2 57.5
Utah 69.8 71.2 60.4 57.9 60.4
Vermont 71.6 72.8 45.7 66.7 67.5
Virginia 69.4 72.7 53.7 64.9 52.9
Washington 71.4 74.2 63.1 58.7 63.0
West Virginiab 77.9 70.1 54.6 54.8 71.1
Wisconsin 72.1 71.6 66.9 71.6 64.8
Wyoming 69.5 60.3 52.4 61.0 65.3

Note: Percentages are age-adjusted to the 2000 US standard population.
Data source: Centers for Disease Control and Prevention, United States Diabetes Surveillance System and National Health Interview Survey.
a Data for 5 states are from 2013 because 2014 and 2015 data were not available.
b Data for 8 states are from 2014 because 2015 data were not available.
c Data for Idaho were not available for 2013, 2014, or 2015.

Healthy People 2020 monitors progress towards increasing the percentage of people with diagnosed diabetes who follow preventive care practices. Table 3 shows the Healthy People 2020 target percentages for each practice and the all-states median percentages for each practice during 2011–2015.

Table 3. Healthy People 2020 Targets and All-States Median Percentages of US Adults Aged 18 or Older with Diagnosed Diabetes Who Reported Receiving Recommended Preventive Care Practices, 20112015

Healthy People 2020 Targets and All-States Median Percentages of US Adults Aged 18 or Older with Diagnosed Diabetes Who Reported Receiving Recommended Preventive Care Practices, 2011–2015
Year Two or more A1c Tests in the Last Year Foot Exam by Health Professional in the Last Year Ever Attended Diabetes Self-Management Class Dilated Eye Exam in the Last Year Daily Self-Monitoring of Blood Glucose
Healthy People 2020 Target 71.1 74.8 62.5 58.7 70.4
2011 68.8 70.8 56.3 60.1* 64.2
2012 69.1 69.1 55.3 59.7* 63.5
2013 67.3 69.2 55.8 59.5* 64.1
2014 68.0 68.0 55.3 58.8* 63.5
2015 71.4* 71.6 54.4 61.6* 63.0

Notes: Percentages are age-adjusted to the 2000 US standard population.
*Percentages meet or exceed the Healthy People 2020 target.

Data sources: Centers for Disease Control and Prevention, United States Diabetes Surveillance System and National Health Interview Survey.

The only recommended practice that consistently met or exceeded the Healthy People 2020 target was the dilated eye exam. In 2015, the goal of having two or more A1c tests in the last year was also met. The all-states median percentage for ever attending a diabetes self-management class was the lowest among all of the preventive care practices. DSMES programs can increase the use of preventive care services, help improve quality of life for people with diabetes, and reduce health care costs by lowering the risk of complications.11 However, barriers such as not having insurance coverage and living in a rural area can make it hard for some people to participate. To address gaps in diabetes preventive care, more research may help find new ways to overcome the challenges that prevent people from accessing DSMES programs.4

Additional national and state data are available in the United States Diabetes Surveillance System. This interactive web application allows users to view data in the form of customized maps, charts, and tables on desktop and mobile devices. The Healthy People 2020 Diabetesexternal icon website provides additional diabetes-specific objectives and recommended practices.

References
  1. Centers for Disease Control and Prevention. Division of Diabetes Translation website. Reports to Congress. https://www.cdc.gov/diabetes/library/reports/congress.html. Accessed September 20, 2017.
  2. Patient Protection and Affordable Care Act of 2009. L No. 111-148,external icon Title X, Sec 10407, 42 USC 247b-9a.
  3. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2017.
  4. Rutledge SA, Masalovich S, Blacher RJ, Saunders MM. Diabetes self-management education programs in nonmetropolitan counties — United States, 2016.external icon MMWR Surveill Summ. 2017;66(10):1–6.
  5. Beckles GL, Chou C. Disparities in the prevalence of diagnosed diabetes — United States, 1999–2002 and 2011–2014. MMWR Morb Mortal Wkly Rep. 2016;65(45):1265–1269.
  6. Luo H, Beckles GL, Zhang X, Sotnikov S, Thompson T, Bardenheier B. The relationship between county-level contextual characteristics and use of diabetes care services. pdf icon[PDF – 1 MB] J Public Health Manag Pract. 2014;20(4):401–410.
  7. US Department of Health and Human Services. Healthy People 2020 website. Social Determinants of Health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-healthexternal icon. Accessed September 1, 2017.
  8. Dabelea D, Mayer-Davis EJ, Saydah S, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014;311(17):1778–1786.
  9. Mayer-Davis EJ, Lawrence JM, Dabelea D, et al. Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012. N Engl J Med. 2017;376:1419–1429.
  10. Saydah S, Imperatore G, Cheng Y, Geiss LS, Albright A. Disparities in diabetes deaths among children and adolescents — United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2017;66:502–505.
  11. Powers MA, Bardsley J, Cypress M, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.external icon J Acad Nutr Diet. 2015;115(8):1323–1334.
  12. Centers for Disease Control and Prevention. Diabetes Prevention Impact Toolkit website. https://nccd.cdc.gov/Toolkit/DiabetesImpact. Accessed May 25, 2017.
  13. The Policy Surveillance Program and ChangeLab Solutions. Health Insurance Coverage Laws for Diabetes Self-Management Education and Training website. http://lawatlas.org/datasets/diabetes-self-management-education-lawsexternal icon. Accessed May 25, 2017.
  14. Centers for Disease Control and Prevention. Diabetes State Burden Toolkit website. https://nccd.cdc.gov/Toolkit/DiabetesBurdenexternal icon. Accessed May 25, 2017.
  15. National Association of Chronic Disease Directors. National Diabetes Prevention Program Coverage Toolkit website. http://www.nationaldppcoveragetoolkit.org/external icon. Accessed July 13, 2017.
Page last reviewed: June 14, 2019