Diabetes Health Campaign - Part I
HCS/535
March 4, 2013

Diabetes Health Campaign - Part I
Diabetes is a disease that has reached epidemic proportions. In the United States approximately 23.6 million people are affected by diabetes making diabetes the 7th leading cause of death (Healthy People 2020, 2012). Diabetes is a disease that results in the body either not producing or not using insulin properly. Complications from uncontrolled diabetes can result in devastating effects on almost every system in the body. Diabetes is so prevalent that the disease has become a national health objective in the Healthy People 2020 agenda. In 2010 North Carolina had approximately 700,000 adults with a diagnosis of diabetes (North Carolina Division of Public Health, 2011). The unfortunate reality is that approximately one-third of the people in North Carolina have not yet been diagnosed and the screening test, a simple blood test, has only been utilized by approximately 60% of North Carolinians (North Carolina Division of Public Health, 2011). Diabetes is a very costly disease and plays havoc on a person’s body. In this paper the subject of discussion is the public health issue of diabetes and its effect on the communities and population of North Carolina.
Diabetes and Healthy People 2020 Healthy people 2020 continues the three decades old national program that is scientifically based and identifies national goals and objective that span over a 10 year period (Centers for Disease Control and Prevention, 2013). Healthy People work to improve health, health promotion, and disease prevention for everyone in the United States (Centers for Disease Control and Prevention, 2013). The benchmarks that Healthy People has put into place have identified national health improvement priorities but also worked to increase the public’s awareness and education of risk factors, diseases, and disability. Healthy people 2020 can produce objectives and goals that affect the nation, individual states, and local communities. This takes place through using measurable data that give credence to what healthy people is trying to accomplish (Centers for Disease Control and Prevention, 2013). Healthy people pushes multiple organizations, agencies, and sectors to stop standing idly by and take action to develop better policies regarding priority health problems and improve practices by using available evidence and knowledge. Healthy People also identify important needs regarding data collection and the analysis of the data. Diabetes is so prevalent it was made a national health objective for Healthy People 2020. Healthy People 2020 targets 16 objectives to help reduce the prevalence of the disease and reduce the economic burden it causes. Diabetes is a chronic disease that if not properly controlled progresses to cause severe complications. People with diabetes have a lower life expectancy by 15 years than non-diabetics, increased risk of heart attack and stroke, is one of the top reasons for kidney failure, lower limb amputations, and retinopathy (Healthy People 2020, 2012). In 2007 the cost of treating diagnosed diabetes was $174 billion that includes $116 billion for direct medical costs, and $58 billion for indirect cost (American Diabetes Association, 2011). Something must be done to reduce the prevalence and cost of the disease.
Federal, State, and Local Agencies Addressing Diabetes
Agencies at each level are work to address diabetes and its burden to the people of the United States. On a Federal level there are several agencies working on the diabetic health issues. Some of those agencies include the Centers for Disease Control and Prevention’s Public Health Resource the Division of Diabetes Translation (DDT), National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Diabetes Information Clearinghouse (NDIC), National Diabetes Education Program (NDEP), Agency for Health care Research and Quality (AHRQ), American Diabetes Association (ADA), National Eye Institute, Office of Minority Health Resources Center, and United States Department of Agriculture (USDA). North Carolina agencies tasked with addressing the diabetic health issues include North Carolina State Diabetes Control and Treatment Branch, North Carolina Diabetes Education Recognition Program, and Department of Health and Human Resources, North Carolina Diabetes Advisory Council, and North Carolina Public Health. Local or community agencies tasked with addressing diabetes include health department, local physician office, local hospitals, and local American Diabetes Association chapters.
Models, Systems, and Epidemiologic Surveillance Systems Used in Diabetes Analysis
The best way to learn what impact diabetes has on the United States is through public surveillance. An infrastructure of national and state surveillance systems supported by the CDCs Division of Diabetes Translation (DDT) works to analyze, interpret, and report on diabetes, specifically “diabetic risk factors, care practices, morbidity, and mortality” (Desai, Geiss, Mukhtar, Harwell, Benjamin, & Bell, 2003, P. S44). The DDT has an area whose sole purpose is to perform national surveillance of diabetes that takes place throughout the entire United States. The goal is to gather information to help understand diabetes in certain areas or with certain populations and report those findings. The problem with gathering data for diabetes is that there are many people with diabetes that have not been diagnosed so there is a large amount of data missing and since physicians are not required to report diabetes diagnosis data can be left out. The data collected comes from information gathered from hospital stays, physician offices, and surveys such as National Health Interview Study. The DDT has to rely on partnerships with other organizations to gather data and the relationship with individual states is very important. The DDT relies heavily on state-based diabetes surveillance systems including staff required for surveillance, money required to conduct the surveillance and special studies. Several other data sources including surveys, “the U.S Renal Data system, the Indian Health Service, information on hospital inpatients, birth and death certificates, and special studies to are utilized to understand the usefulness of data from managed care, Medicare, and Medicaid for monitoring diabetes” (Desai, Geiss, Mukhtar, Harwell, Benjamin, & Bell, 2003, P. S44). Once the data is gathered and analyzed it is used to determine the prevalence of diabetes and indicators associated with diabetes. This includes looking at risk factors not only on a broad basis such as the United States as whole but also individual states especially when looking at how diabetes affects specific populations. Data is useful in determining how effective population-based treatment, care, policy making, any research needs, and measuring the progress towards meeting the objectives of states and the nation. Reports are generated by each state and by the DDT then used in developing programs or changing anything that can improve diabetic outcomes.
Tools in other areas of health care are also useful in addressing the issue of diabetes. These tools consist of risk assessment and disease and health trends. These tools allow investigators to help determine who is at risk for developing the disease and how this can be prevented or decreased. These tools also allow determining how the disease is affecting other diseases. An example is how people with diabetes are at a higher risk for heart disease and kidney disease. By monitoring disease and health trends one can see the prevalence of diabetes on these diseases and if any measures taken to fight diabetes is having a positive or negative affect on the prevalence of these comorbidities.
Diabetes in Racial and Ethnic Communities
There has long been emphasis placed on improving minority health and access to health care for minorities. Diabetes is creating a devastating effect on minority populations including African Americans, American Indians, Alaskan Natives, Hispanic, and Asian Americans. Recently the CDC released data stating that “Black non-Hispanic, Mexican Americans, and residents of Puerto Rico are 2.0 times and American Indians and Alaskan Natives are 2.6 times more likely to have diabetes as their non-Hispanic White counterparts” (Liburd & Vinicor, 2003, P. S74). Diabetes and the complications of diabetes tend to be excessive in minority populations. For North Carolina generally citizens with higher education and income tend to have better health and better health outcomes than people with low education and low income. One area that did not correlate to the education and income level was African Americans. This ethnic group still generally had higher levels of diabetes than Whites. In 2010 in North Carolina approximately 37.8% of African Americans age 65 and older had diabetes (North Carolina Division of Public Health, 2011). For North Carolina diabetes is the 7th leading cause of death and the 4th leading cause of death for African Americans resulting in a 2.7 times higher mortality rate than for White (North Carolina Division of Public Health, 2011). This means that North Carolina has much work to do to decrease the prevalence of diabetes in African Americans and other minorities. This can be accomplished by using the state surveillance systems to improve diabetes health care targeting the minority population especially in the area of self-care. Self-care is an area that minorities tend to fall short on. Importance of checking blood glucose levels at home is very important in the self-management of diabetes.
Conclusion
Diabetes has become an epidemic in the United States. The only way to fight this epidemic and improve diabetic outcomes is through data collection and analysis of the data. By using national and state level surveillance systems data has shown that minorities have a higher prevalence of diabetes and its complications. In North Carolina African Americans have an extremely high rate of diabetes. Through state diabetes councils and getting the local agencies such as the health departments, physician’s office, local American Association of Diabetes, and hospitals efforts can be made to eliminate diabetes or at the very least reduce the prevalence of diabetes throughout North Carolina and the United States. Healthy People 2020 is working very hard with its objectives to accomplish this. References
American Diabetes Association. (2011). Diabetes Statistics. Retrieved from http://w
Centers for Disease Control and Prevention. (2013). Healthy People History. Retrieved from http://ww
Desai, J., Geiss, L., Mukhtar, Q., Harwell, T., Benjamin, S., & Bell, R. (2003). Public health surveillance of diabetes in the United States. Journal of Public Health Management & Practice, 9(2), S44-S51.
Healthy People 2020. (2012). Topic and objectives: Diabetes. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview
Liburd, L. C., & Vinicor, F. (2003). Rethinking diabetes prevention and control in racial and ethnic communities. Journal of Public Health Management Practice, 9(Nov), S74-S79.
North Carolina Division of Public Health. (2011). Diabetes Prevention and Control. Retrieved from http://w