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State of Alaska

Health Indicator Report of Diabetes Prevalence

Diabetes is a group of diseases characterized by high levels of glucose (a form of sugar) in the blood over a prolonged period. High blood sugar happens when the body cannot produce enough insulin, a hormone that helps lower blood sugar, or when the body cannot use its own insulin properly. Diabetes can lead to serious health complications, such as heart disease, stroke, kidney disease, blindness, leg and feet amputations, and early death.^1^ There are three main types of diabetes, as well as a condition called prediabetes. Type 1 diabetes, in which the pancreas does not produce insulin due to an autoimmune disease, can develop at any age, but is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. About 5% of people with diabetes have this form of the disease and there is no known way to prevent it. Type 1 diabetes requires treatment in the form of insulin shots or an insulin pump. In addition to insulin therapy, exercise and careful attention to diet are necessary to prevent fluctuations in blood glucose levels. In type 2 diabetes, the pancreas does not produce enough insulin or the body does not use it properly (insulin resistance). Type 2 diabetes is often considered a lifestyle disease because it is normally triggered by living a fairly sedentary life, being overweight, and not participating in exercise. The risk of developing this type of diabetes is associated with aging, obesity, a family history of diabetes, a personal history of gestational diabetes, lack of physical activity, and race and ethnicity. About 90%-95% of all cases of diabetes are type 2 diabetes.^1^ The third type of diabetes is gestational diabetes, which develops only during pregnancy, usually in the second or third trimester. It is estimated that up to 9.2% of all pregnant women develop gestational diabetes.^2^ Unlike type 1 and type 2 diabetes, gestational diabetes disappears after the baby is born. However, women who have had gestational diabetes are more likely to have it again in the next pregnancy, and are also at higher risk of developing type 2 diabetes later in life. Prediabetes, also known as impaired glucose tolerance, is a condition where the blood glucose level is higher than normal, but not high enough to be considered diabetes. People who have prediabetes are at increased risk of developing type 2 diabetes, heart disease, and stroke. Participating in a structured lifestyle change program that promotes weight loss, increased physical activity, and a healthy diet has been shown to reduce the risk of developing type 2 diabetes by as much as 58% among people with prediabetes.^3^ Diabetes has reached epidemic proportions in the United States. According to the Centers for Disease Control and Prevention, the number of Americans with diabetes has increased 50% in the last decade to 29.1 million, or 9.3% of the population.^3^ Another 8.1 million people with diabetes do not know they have it (undiagnosed). Diabetes takes more lives than AIDS and breast cancer combined, claiming one American every three minutes.^4^ More than 20% of health care spending is for people with diagnosed diabetes.^5^ The estimated total economic cost of diagnosed diabetes in 2012 is $245 billion.^6^ The incidence (new cases) of diabetes is estimated to increase from 8 cases per 1,000 in 2008 to about 15 cases per 1,000 in 2050.^7^ About 86 million adults, or more than 1 in 3, have prediabetes. If current trends continue, as many as 1 in 3 people in the United States could have diabetes by the year 2050.^4^ Challenges for diabetes include the risk of complications due to the disease. In order to reduce the burden of disease, we need to identify those at risk, implement effective preventive strategies, and manage metabolic factors known to contribute to diabetes complications.[[br]] [[br]] ---- {{class .SmallerFont See "'Resources and References"' tab for references. }}

Notes

** = Data not available. The value for the U.S. for 2014 was not immediately available. U.S. value is the ranked median of states, District of Columbia, and territories.

Data Sources

  • Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion
  • U.S. Data: National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System (BRFSS)

Data Interpretation Issues

The [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] is the primary source for estimating diabetes prevalence for Alaska. The median of states, District of Columbia, and territories provide a comparison for the United States (U.S.). The BRFSS is a telephone survey of adults 18 and over. Information on background and methodology of the BRFSS managed by the Centers for Disease Control and Prevention (CDC) can be found at: [http://www.cdc.gov/brfss/]. The website for the Alaska BRFSS is: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx]. The question on diabetes has been asked on the standard BRFSS (1991 onward) as well as the supplemental BRFSS survey since its inception in 2004. Alaska Native people in analyses of the BRFSS refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals who indicate multiple races including American Indian/Alaska Native are considered Alaska Native in the data. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class. This definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium health care services.

Definition

Percentage of adults 18 years of age and older who responded "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "Has a doctor, nurse, or other health professional ever told you have diabetes?" Responses of "Yes, but female told only during pregnancy" are not considered as a positive response for having diabetes.

Numerator

Weighted number of adults (18+) who responded "Yes" on the BRFSS to the question: "Has a doctor, nurse, or other health professional ever told you have diabetes?" Responses of "Yes, but female told only during pregnancy" are not considered as a positive response for having diabetes.

Denominator

Weighted number of adults (18+) with complete and valid responses to the question: "Has a doctor, nurse, or other health professional ever told you have diabetes?", excluding those with missing, "Don't know/Not sure", or "Refused" responses.

How Are We Doing?

The prevalence of diabetes has risen steadily, both nationally and in Alaska. Several factors contribute to the continual climb in diabetes prevalence. Increasing rates of obesity and sedentary lifestyles add to the number of people at risk for developing diabetes, while improvements in medical care mean people with diabetes are living longer. The 1997 change in the key diagnostic criterion (fasting blood glucose >126 mg/dL) contributed to the increased number of people who were clinically diagnosed. Diabetes prevalence rates from the BRFSS are initially presented for all Alaskans, Alaska Native people, and the median from states, District of Columbia, and territories for all available years. Subsequent analyses by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status) are limited to 2010 and later to allow for ease of assessing recent trends. People under the age of 45 were at decreased risk for diabetes when compared to those 45 years of age and older. Non-Hispanic Blacks experienced higher rates of diabetes when compared to all other races. Those with less than a high school education were more likely to report diabetes when compared to college graduates. People who were unable to work reported higher rates of diabetes compared to those who were employed, unemployed, or not in the work force. Crosstabulations were also conducted for three-year averages by body mass index, current smoking, sexual orientation, and disability. Only the significant differences evident in contrasts by body mass index and disability are presented but the other results are available upon request. Diabetes prevalence by regions of Alaska are presented for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) single-year for the 6 Alaska Public Health Regions, 2) three-year averages by the 7 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) single-year for the 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) three-year averages for 29 boroughs and census areas, and 5) five-year averages for the 12 tribal health organization regions. These time intervals match those for the InstantAtlas health profiles for each of the geographic regions of Alaska, for those desiring longer time series.

How Do We Compare With the U.S.?

The percentage of adults with diabetes in Alaska is lower than that for the United States. In Alaska, the crude rate of adults diagnosed with diabetes was 7.8% for 2014. For the United States, the crude prevalence was 10.1% in 2014 (the most recent national BRFSS data available). In Alaska, about 37,000 adults have been diagnosed, while an estimated additional 11,600 Alaska adults have diabetes but do not know they have it. An estimated 25.9% of Americans aged 65 or older (11.2 million people) have diabetes. There is little gender difference in the prevalence of diabetes. In the United States population aged 20 or older, the prevalence is 15.5% for males and 13.4% for females.

What Is Being Done?

The [http://dhss.alaska.gov/dph/chronic/pages/diabetes/default.aspx Alaska Diabetes Prevention and Control Program (DPCP)] works to increase public awareness of the warning signs, symptoms, and risk factors for developing diabetes. The program seeks innovative ways to encourage people to recognize that they may be at risk and should get tested. The program promotes glycated hemoglobin (a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods) awareness through A1C testing among people already diagnosed with diabetes, and has produced television and radio public service announcements stressing the urgency of getting A1C levels under control. The DPCP, in conjunction with the Alaska Health Plan Partnership, has also developed and distributed materials that remind Alaskans with diabetes of the importance of managing their ABCs (A1C, blood pressure, cholesterol levels, and stop smoking or don't start). The Program assists community-based organizations as they work to increase awareness of diabetes and its risk factors among members of their population. The DPCP has established partnerships with Southcentral Foundation, the Alaska Native Tribal Health Consortium, YMCA, the UAF Cooperative Extension Service, and Bartlett Regional Hospital, to name a few. The DPCP strongly encourages diabetes self-management education (DSME) for persons with diabetes from an [http://www.diabetes.org/ American Diabetes Association (ADA)] or [https://www.diabeteseducator.org/ American Association of Diabetes Educators (AADE)] accredited program. Diabetes prevention programs are also encouraged for those with prediabetes. DSME is recommended by the 2015 U.S. Preventive Services Task Force (USPSTF) Clinical Guidelines. For more information about DSME or diabetes prevention program classes near you, contact the Alaska Diabetes Prevention and Control Program at [http://www.diabetes.alaska.gov].

Evidence-based Practices

The National Diabetes Prevention Program (DPP) showed that weight loss and participation in regular physical activity can significantly decrease the risk of developing type 2 diabetes. The DPP clinical trial included over 3,000 people who had impaired fasting glucose and were at an increased risk for developing diabetes.^9^ Participants who engaged in moderately intense physical activity for 30 minutes per day and lost 5 to 7% of their body weight decreased their risk of diabetes dramatically. This behavioral activity was effective for all groups of participants in the study, regardless of age or ethnic group.[[br]] [[br]] ---- {{class .SmallerFont 9. Knowler WC, Fowler SE, Hamman RF, Christophi CA, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009;374(9702):1677-86. }}

Available Services

'''Services Available to the Public:''' Alaska Diabetes Prevention and Control Program [http://dhss.alaska.gov/dph/Chronic/Pages/Diabetes/default.aspx] Diabetes and Lipid Clinic of Alaska [http://www.diabetesalaska.com/] American Diabetes Association - Alaska office [http://www.diabetes.org/in-my-community/local-offices/anchorage-alaska/] Living Well Alaska - Chronic Disease Self-Management Program [http://dhss.alaska.gov/dph/chronic/pages/selfmanagement/default.aspx] Southcentral Foundation Health Education and Wellness Programs [https://www.southcentralfoundation.com/services/health-and-wellness-programs/] Alaska Regional Hospital - Diabetes Center [http://alaskaregional.com/hl/?/33718/Diabetes-Center] Bristol Bay Area Health Corporation - Diabetes Prevention and Lifestyle Change Program [http://www.bbahc.org/index.asp?SEC=7A25D331-8C36-465C-A6F8-604B22B69160&Type=B_BASIC] Bartlett Regional Hospital - Diabetes Education [http://www.bartletthospital.org/services/diabetes-education.aspx] Diabetes Prevention and Control Program YKHC [http://www.ykhc.org/diabetes/] Diabetes Prevention - SEARHC [http://www.searhc.org/services/health-promotion/diabetes-services] Tanana Chiefs - Diabetes Services [https://www.tananachiefs.org/health/medical/diabetes/] Norton Sound Health Corporation - Chronic Care Active Management and Prevention (CAMP) [https://www.nortonsoundhealth.org/Divisions/Hospital-Services/Diabetes---CAMP ] Cross Road Medical Center - Diabetes Local [http://www.diabeteslocal.org/resource/cross-road-medical-center-glennallen] Mt. Sanford Tribal Consortium - Diabetes Program [http://www.mstc.org/diabetes.html] Peace Health Ketchikan Medical Center - Diabetes Education [https://www.peacehealth.org/ketchikan/services/diabetes-education/Pages/Default.aspx] FOR MORE LOCATIONS CHECK OUT THE ALASKA DIABETES RESOURCE GUIDE: [http://dhss.alaska.gov/dph/Chronic/Documents/Diabetes/data/2009_AK_Diabetes_Resource_Guide.pdf]
Page Content Updated On 03/15/2017, Published on 03/15/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sun, 24 September 2017 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Wed, 15 Mar 2017 15:20:52 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sun, 24 September 2017 2:14:12 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Wed, 15 Mar 2017 15:20:52 AKDT