Diabetes is a disorder of metabolism--the way our bodies use digested food for growth and energy. Currently, diabetes affects nearly 8% of U.S. adults and 19% of older adults (AHRQ, number 280, December 2003).  Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2000, it was the sixth leading cause of death. However, diabetes is likely to be underreported as the underlying cause of death on death certificates. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke (NDIC, 2004).

Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

In 2002, diabetes cost the United States $132 billion. Indirect costs, including disability payments, time lost from work, and premature death, totaled $40 billion; direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $92 billion (NDIC, 2004).

The three main types of diabetes are: type 1 diabetes , type 2 diabetes, and gestational diabetes.  Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States.  Type 1 diabetes develops most often in children and young adults, but the disorder can appear at any age. The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight. Type 2 diabetes is increasingly being diagnosed in children and adolescents. Lastly, there is gestational diabetes which develops only during pregnancy. It occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years (NDIC, 2004).

The following article examines general diabetes prevalence among adults 18 years of age and older in Southeastern Pennsylvania (SEPA).  The data presented are from PHMC’s 2002 SEPA Household Health Survey.

Prevalence of Diabetes among adults in SEPA

The prevalence of diabetes among adults in SEPA has nearly doubled in the past decade, increasing from 4.1% in 1991 to 7.7% in 2002.  Now almost 8% (7.7%) of adults in SEPA have diabetes. Although this percentage is small, it represents a sizable number of adults in the region (221,700). 

Among adults, certain population groups are more likely to have diabetes than others. 

• Black adults (12.6%) are more likely to have diabetes than are Latino (9.8%) or white (6.4%) adults.  Asian adults (2.3%) are the least likely racial/ethnic group to have diabetes.  (See Figure 1)
• Male adults are slightly more likely to have diabetes compared to female adults (7.9% versus 7.5%).
• Age appears to be a factor in diabetes prevalence.  Older adults ages 75+ (18.1%) and those ages 60-74 are more likely to have diabetes (17.9%) compared to adults ages 50-59 (10.9%), 40-49 (4.7%) and 18-39 (1.8%).
• Adults living below the Federal Poverty Level are more likely to have diabetes (13.4%) compared to non-poor adults (7.0%).   
• Adults with insurance are twice as likely to have diabetes than are the uninsured (8.0% versus 4.1%, respectively).

Health Status of Adults with Diabetes

Due to the close association of diabetes to other diseases, it is important that people with diabetes have a regular source of care to help monitor their health status and obtain specific disease related health screenings such as eye exams and blood pressure checks. 

• The majority of adults with diabetes have a regular source of care (93.8%) compared to 88% of adults without diabetes. 
• Adults with diabetes are more likely to have more visits to a doctor’s office in the past year compared to adults without diabetes (average of 7.7 visits compared to 4.5 visits).
• The majority of adults with diabetes (98.8%) have had their blood pressure checked in the past year.  
• More than one-half of adults with diabetes are in fair/poor health (56.4%) compared to 16.2% of adults without diabetes.  The percentage of adults with diabetes in fair/poor health represents 124,000 adults in SEPA.  (See Figure 2)
• Slightly more than one-third (34.1%) of adults with diabetes have a heart condition, and six out of ten have high blood pressure (63.3%).
• Among adults with diabetes, almost one-quarter (23.3%) have not had their eyes checked in the past year. 

The health behaviors of adults with diabetes, including cigarette smoking, exercise and weight control, are important indicators of potential future health conditions related to or associated with diabetes.  Among adults with diabetes, many report that they are taking measures to control their disease, including: taking medication (54.2%), changing their eating habits (19.9%), taking insulin (18.2%) and exercising more (2.6%).  However, there are still many adults with diabetes who have not changed their health behaviors.

• Nearly fifteen percent (14.4%) of adults with diabetes smoke cigarettes compared to one out of five (21.2%) adults without diabetes. 
• Only one-quarter (25.6%) of adults with diabetes exercises regularly or more than three days a week compared to three out of ten adults without diabetes (31.3%).  Almost one-quarter (23.7%) never exercise compared to 14 .2% of adults without diabetes.
• Nearly half of adults with diabetes are obese (47.8%) compared to one out of five adults without diabetes (20.4%).  Additionally, one-third (35.2%) of adults with diabetes are overweight.  (See Figure 3)

The above findings show that adults with diabetes have poorer health status and health behaviors, and are not always getting critical health screenings. The data underscore the need for more attention focused on helping persons with diabetes understand their disease   and the associated health risks.  For more information on diabetes, please contact Francine Axler, Senior Research Associate at Francine@phmc.org.