Priority: DIABETES

TABLE OF CONTENTS

1. Health Data
2. Unmet Needs
3. Resources in Chautauqua County
4. Opportunities for Action

Diabetes is a chronic disease that usually manifests itself as one of two major types: type 1, mainly occurring in children and adolescents 18 years and younger, in which the body does not produce insulin and thus insulin administration is required to sustain life; or type 2, occurring usually in adults over 30 years of age, in which the body's tissues become unable to use its own limited amount of insulin effectively.
 
The occurrence of diabetes, especially type 2 diabetes, as well as associated diabetes complications, is increasing in the U.S. The number of persons with diabetes has increased steadily over the past decade; presently, 10.5 million persons have been diagnosed with diabetes, while 5.5 million persons are estimated to have the disease but are undiagnosed. This increase in the number of cases of diabetes has occurred particularly within certain racial and ethnic groups.
 
Diabetes is most common in persons over age 60 years. As the population in the U.S. ages, especially as the number of persons aged 60 years and older grows, an increase in the number of people with diabetes is expected. While studies indicate that aging itself may not be a major factor in the substantial increase in the number of persons with diabetes, present and future prevention strategies for diabetes will be associated with a greater lifespan for persons with diabetes. The following chart illustrates the proportions with diabetes by race/ethnic and adult age groups in the U.S. http://www.healthypeople.gov/document/Word/Volume1/05Diabetes.doc

Figure 1. Diabetes in the U.S. Population
by Age and Race/Ethnicity, 1988-94.

Sources: Harris, M., Flegal, K., Cowie, C., et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose intolerance in U.S. adults: The Third National Health and Nutrition Examination Survey, 1998-1994. Diabetes Care 21 (4):518-524, 1998. Indian Health Service, national outpatient database.
 
(http://www.healthypeople.gov/document/Word/Volume1/05Diabetes.doc)

Issues and Trends

Diabetes poses a significant public health challenge for the United States. Some 800,000 new cases are diagnosed each year, or 2,200 per day. The changing demographic patterns in the U.S. are expected to increase the number of people who are at risk for diabetes and who eventually develop the disease. Over the past decade, diabetes has remained the seventh leading cause of death in the United States, primarily from diabetes-associated cardiovascular disease www.healthypeople2010.gov/diabetes.

Recent data for diabetes in New York State are presented in Table 1. Two important findings shown in the table are that the majority with diabetes is age 45 or older, and an estimated 50 percent of those with diabetes have not been diagnosed.

* http://www.health.state.ny.us/nysdoh/consumer/diabetes/conover.htm
**http://www.health.state.ny.us/nysdoh/consumer/diabetes/surv/en/contents.htm

Healthy People 2010 and Diabetes

The following chart presents the Healthy People 2010 targets for the objectives pertinent to diabetes, along with baseline data for the year(s) indicated. This chapter will examine Chautauqua County data for the indicators listed in bold type.

A. Health Data

Table 2 shows estimates for adults age 20+ years with diagnosed diabetes in Chautauqua County, 1997-99.

Prevalence estimates at the county level were derived by applying the age/race specific New York State prevalence rates to the 1997-1999 census county age/race specific population estimates. Source: New York State BRFSS and U.S. Census Population Estimates, 1997-1999. Produced by the New York State Department of Health Diabetes Surveillance and Evaluation Unit http://www.health.state.ny.us/nysdoh/consumer/diabetes/surv/en/prevalence.htm

For discharge year 2003, Chautauqua County had a hospitalization discharge rate for diabetes of 15.69 per 10,000 residents. As Table 3 and Figure 2 show, this is a lower rate of hospitalizations than in western New York or New York State (16.31 and 19.62 per 10,000 residents, respectively).

Figure 2. Average Diabetes Hospitalization Rates for Counties
in New York State per 10,000 Residents, 2003.

(https://commerce.health.state.ny.us/hpn/cgi-bin/applinks/sparcs/sparcs3.cgi/diabhrate)

The rate of diabetes hospitalizations for people with diabetes in Chautauqua County (454.9 per 1,000 diabetics, or 45.5%) is somewhat higher than the rate in New York State (420.5 per 1,000 diabetics, or 42.05%). See Table 4.

Chautauqua County currently has a rate of mortality due to diabetes that is lower than the Healthy People 2010 target, (16.1) and also lower than across western New York and New York State (21.0 and 19.7, respectively), as Table 5 indicates.

Source: 1998-2000 Vital Statistics Data as of August, 2004. * Adjusted Rates Are Age Adjusted to the 2000 United States Population (https://commerce.health.state.ny.us/hin/).

Although the diabetes mortality rate has fluctuated during this time period, the single-year rate decreased from 23.1 in 1993 to 17.3 in 2002, and the decline also is evident in the 3-year average death rate (see Figure 3).

Figure 3. Trends in Diabetes Mortality
for Chautauqua County, 1993-2002.


(http://www.health.state.ny.us/nysdoh/chac/cha00/plots/chronic/diabet6.htm)

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B. Unmet Needs

Summary: Diabetes in Chautauqua County

Chautauqua County has a lower average hospitalization rate per resident population than in western New York or New York State (2003). However, the rate of diabetes hospitalizations per resident diabetic was slightly higher in the County than in New York State (1999).

The County currently has a rate of mortality due to diabetes that is lower than the Healthy People 2010 target, and lower than western New York and New York State. Although the mortality rate has fluctuated during this time period, the single-year morality rate decreased from 1993 to 2002, and the decline also is evident in the 3-year average death rate.

Healthy People 2010

while pre-menopausal non-diabetic women usually are at less risk of cardiovascular disease than men, the presence of diabetes in women is associated with a three- to four-fold increase in coronary heart disease compared to non-diabetic females. In the U.S., diabetes is the leading cause of non-traumatic amputations (approximately 150 per day); blindness among working-aged adults (approximately 60 per day); and end-stage renal disease (ESRD) (approximately 70 per day).
 
These and other health problems associated with diabetes contribute to an impaired quality of life and substantial disability among people with diabetes. Diabetes is a costly disease; estimates of the total attributable costs of diabetes are around $100 billion. Hospitalizations for diabetes-associated cardiovascular disease account for the largest component of the direct costs. However, diabetes management is occurring increasingly in the outpatient setting, and more people with diabetes are using nursing home facilities (www.healthypeople2010.gov/diabetes).

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C. Resources in Chautauqua County

The following are Chautauqua County organizations, agencies, programs and other service providers that offer assistance for managing diabetes.

• 3 Dieticians: Karen Collins; Mary Damiano, MS, RD
   
  
• Health insurance plans providing payment for diabetes counseling and monitoring
   
  
• 4 Hospital dietetics departments
  
  WCA Hospital, Brooks Memorial Hospital, Lake Shore Hospital, Westfield Memorial Hospital
  
  
• 2 Hospital-based diabetes support groups:
  
  WCA Hospital, Jamestown -- Certified diabetes education staff.
  Brooks Hospital, Dunkirk (?)
  
  
• NYS Cooperative Extension Office Nutrition Counseling
   
  
• 18 Pharmacies providing test strips, other diabetic equipment
   
  
• 76 Internal Medicine & Family Medicine/Family Practice Physicians
   
  
• 10 OB/GYN
   
  
• Podiatrists
   
  
• STEPS Consortium

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D. Opportunities for Action

It is estimated that 50% of the general New York State population with diabetes has not been diagnosed (http://www.health.state.ny.us/nysdoh/consumer/diabetes/conover.htm). Chautauqua County has high percentages of residents ages 45-64 years (23%) and ages 65+ (16%) (see SECTION 1, this document). Of those diagnosed, 84% were diagnosed after age 45 (see Table 1, this chapter). In the U.S., the highest rate of diabetes by race/ethnicity for ages 60+ years is for Mexican Americans (see Figure 1, this chapter). Approximately 4.18% of the Chautauqua County population is Hispanic or Latino (see SECTION 1). As the numbers of older residents and other at-risk groups increase, the County will need to monitor carefully diabetes trends and health-related issues for these population subgroups.

Opportunities for action in Chautauqua County, derived from objectives to meet the challenges of diabetes in the 2010 Initiative, are presented below.

• Educate and monitor patient protection behaviors (aspirin, self-blood-glucose-monitoring).
   
  
• Reduce the amount of fat and processed foods consumed, as well as total calories.
   
  
• Strengthen and expand diabetes education across the lifespan.
   
  
• Reduce the levels of obesity, improper nutrition, and lack of physical activity in persons under age 15 years. Reduce amount of television watching associated with diminished physical activity.
   
  
• Increase physical activity and reduce obesity pertinent to demographic changes (aging, increased growth of at-risk populations).
   
  
• Increase rates of screening for early diabetes complications (eye, foot, and kidney abnormalities), followed by appropriate treatment and prevention strategies.
   
  
• Monitor and reduce the burden of disease (new cases, existing cases, undiagnosed diabetes, death, pregnancy complications).
   
  
• Prevent, monitor and treat macrovascular, microvascular, and metabolic complications.
   
  
• Add more extensive and enhanced laboratory services for lipids, glycosylated hemoglobin and microalbumin measurements.
   
  
• Increase the number and quality of primary health provider services (eye, foot, and dental examinations).
   
  
• Increase prevention programs that provide daily clinical management of persons with diabetes.
   
  
• Attract specialists to the County, such as endocrinologists and certified diabetes educators.
   
  
• Improve ascertainment and surveillance systems to more completely capture the actual burden of diabetes.
   
  
• Prepare for the present and future burden of diabetes by taking into account factors such as genetics, cultural and community traditions, and socioeconomic status (SES) (www.healthypeople2010.gov/diabetes).
   
  
• Increase the cause-of-death reporting of diabetes. Studies have found that only about 35 percent to 40 percent of decedents with diabetes have diabetes listed anywhere on the death certificate and only about 10 percent to 15 percent have it listed as the underlying cause of death (http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm).

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