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Diabetes: The Epidemic of the 21st Century

Diabetes: The Epidemic of the 21st Century. A Managed Care Perspective: The Arizona Experience Roberto Ruiz, M.D., F.A.C.P. Arizona Demographics. Total Number of Residents 6,440,990 White 58% Hispanic 31% American Indian 8% Black 4%. statehealthfacts.org.

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Diabetes: The Epidemic of the 21st Century

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  1. Diabetes: The Epidemic of the 21st Century A Managed Care Perspective: The Arizona Experience Roberto Ruiz, M.D., F.A.C.P.

  2. Arizona Demographics Total Number of Residents 6,440,990 White 58% Hispanic 31% American Indian 8% Black 4% statehealthfacts.org

  3. Arizona Demographics Health Insurance Coverage (2007-2008) Employer 47.0% Individual 4.7% Medicaid 16.8% Medicare 11.4% Other Public 1.2% Uninsured 18.9% Statehealthfacts.org

  4. Arizona Demographics • Arizona has seen a 44 percent increase in adults with diabetes from 2000 through 2006 • prevalence rising from 5.9 percent to 8.5. • In Arizona, 9.2 percent of Hispanics have diabetes whereas 7.8 percent of non- Hispanic Whites have diabetes. Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition

  5. Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition

  6. Arizona Diabetes Strategic Plan 2008-2013 Arizona Diabetes Coalition

  7. Arizona Demographics Diabetes RelatedDischargesHospital InpatientDischarges 2005 2008 2005 2008 Totals 175,786 209,265 99,111 108,662 < 15 1,197 1,221 15-19 1,495 1,983 20-44 31,750 39,494 45-64 65,658 80,774 65+ 75,685 85,793 Maricopa 97,208 120,578 55,919 62,076 Arizona Department of Health Services

  8. Arizona Demopgraphics Emergency Room Visits 2005 2008 Totals 76,675 100,603 < 15 722 725 15-19 883 1,210 20-44 19,123 25,320 45-64 29,491 40,288 65+ 26,455 33,060 Maricopa 41,289 58,502 Arizona Department of Health Services

  9. Arizona Demographics Patient Days for Inpatient Discharges for Diabetes 2005 2008 Totals 44,637 47,679 < 15 1,095 1,191 15-19 997 1,372 20-44 10,047 11,657 45-64 17,615 19,187 65+ 14,883 14,272 Maricopa 22,263 26,567 Arizona Department of Health Services

  10. Arizona Demographics Patient Days for Inpatient Discharges for Diabetes 2005 2008 American Indian(6.2) 4,560 4,795 Black or African American (4.5)2,420 3,010 Hispanic (4.9)10,896 12,067 White (4.8)24,974 26,431 Arizona Department of Health Services

  11. National Diabetes - 2007 Prevalence of Impaired Fasting Glucose in People < 20 in U.S. In 1999 – 2000, 7% had IFG In 2003 - 2006, 25.9% of Adults 20 yrs. or older had IFG 35.4 % of Adults age 60+ had IFG Applying this percentage to the entire U.S. population in 2007 yields an estimated 57 million American adults aged 20 yrs. Or older, suggesting that at least 57 million American adults had pre-diabetes in 2007 National Diabetes Clearinghouse (NDIC)

  12. National Diabetes - 2007 Prevalence of Diagnosed and Undiagnosed Diabetes in 2007 Total 23.6 Million people 7.8 % of population have diabetes Diagnosed 17.9 million people Undiagnosed 5.7 million people National Diabetes Clearinghouse (NDIC)

  13. National Diabetes - 2007 NHW=Non-Hispanic Whites; AA=African Americans; H=Hispanics; API=Asians/Pacific Islanders; AI=American Indians Source: SEARCH for Diabetes in Youth Study.

  14. Complications of Diabetes in the United States In 2004, heart disease was noted on 68 percent of diabetes-related death certificates among people ages 65 years or older. In 2004, stroke was noted on 16 percent of diabetes-related death certificates among people ages 65 years or older. Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes. The risk for stroke is two to four times higher among people with diabetes. National Diabetes Clearinghouse (NDIC)

  15. Complications of Diabetes in the United States In 2003 to 2004, 75 percent of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or used prescription medications for hypertension. Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. National Diabetes Clearinghouse (NDIC)

  16. Complications of Diabetes in the United States Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2005. In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico. In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico. National Diabetes Clearinghouse (NDIC)

  17. Complications of Diabetes in the United States About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, erectile dysfunction, or other nerve problems. Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations. National Diabetes Clearinghouse (NDIC)

  18. Complications of Diabetes in the United States More than 60 percent of nontraumatic lower-limb amputations occur in people with diabetes. In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes. National Diabetes Clearinghouse (NDIC)

  19. Complications of Diabetes in the United States Periodontal, or gum, disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes. People with poorly controlled diabetes—A1C greater than 9 percent—were nearly three times more likely to have severe periodontitis than those without diabetes. Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more. National Diabetes Clearinghouse (NDIC)

  20. Complications of Diabetes in the United States Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5 to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies. Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child. National Diabetes Clearinghouse (NDIC)

  21. Complications of Diabetes in the United States Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar, or nonketotic, coma. People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes. National Diabetes Clearinghouse (NDIC)

  22. A closer look at my patients…… Southwest Internal Medicine Group

  23. Age Distribution

  24. HbA1c Distribution

  25. HbA1c • Average HbA1c for the Southwest Internal Medicine Group is 6.4 • Average HbA1c for the Nation is 9.0

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