Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.  Currently, diabetes affects nearly 10% of U.S. adults and 21% of adults age 60 and over (CDC, 2005).   A total of 14.6 million persons have diabetes and an estimated 6.2 million persons have diabetes but have not been diagnosed.  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.

Diabetes is associated with long-term complications that affect almost every part of the body and the risk for death among people with diabetes is about twice that of people without diabetes of a similar age.  The disease often leads to heart disease and stroke, high blood pressure, blindness, 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 (CDC, 2005).

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 (CDC, 2005).

In recognition that November was diabetes awareness month, 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 2004 SEPA Household Health Survey.

Prevalence of Diabetes among Adults in SEPA

The prevalence of diabetes among adults in SEPA has more than doubled in the past thirteen years, increasing from 4.3% in 1991 to 9.4% in 2004.  Now almost one in ten adults in SEPA have diabetes.  Although this percentage is small, it represents more than one-quarter million adults in the region (263,400). 

Among adults, certain population groups are more likely to have diabetes than others. 
· Black and Latino adults (14.8% and 14.6%, respectively) are more likely to have diabetes than white (7.8%) adults.  Asian adults (4.3%) are the least likely racial/ethnic group to have diabetes.  (See Figure 1)

· Male adults are equally likely to have diabetes as female adults (9.2% versus 9.1%).

· Increasing age is a factor in diabetes prevalence.  Older adults ages 75+ and those ages 60-74 are more likely to have diabetes (17.2% and 21.0%, respectively) compared to adults ages 50-59 (10.2%), 40-49 (7.5%) and 18-39 (2.7%).

· Adults living below the Federal Poverty Level are two times more likely to have diabetes (18.4%) than non-poor adults (7.9%).   

· Adults with insurance are more likely to have diabetes than are the uninsured (9.4% versus 6.9%, 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 and dental exams and blood pressure checks. 

· The overwhelming majority of adults with diabetes have a regular source of care (95.2%) compared to 88.0% of adults without diabetes.

· The majority of adults with diabetes (51.0%) are in fair/poor health compared to 16.7% of adults without diabetes.  The percentage of adults with diabetes in fair/poor health represents 134,000 adults in SEPA.  (See Figure 2)

· Three in ten (30.6%) of adults with diabetes have a heart condition, and six out of ten have high blood pressure (62.2%).

· The overwhelming majority of adults with diabetes (98.8%) have had their blood pressure checked in the past year.  

· Among adults with diabetes, almost one-quarter (24.6%) have not had their eyes checked in the past year.

· More than one in eight adults with diabetes (13.1%) have not had their glycosolated hemoglobin level checked in the past year, an important indicator of long-term diabetes control. 

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 (49.3%), changing their eating habits (13.3%), taking insulin (24.7%), and exercising more (2.3%).  However, there are still many adults with diabetes who have not changed their health behaviors.

· Nearly nineteen percent (18.8%) of adults with diabetes smoke cigarettes compared to one out of five (23.3%) adults without diabetes. 

· Only one in three adults with diabetes (29.5%) exercises regularly or more than three days a week compared to more than one-third of adults without diabetes (36.4%).  Almost one-quarter (25.3%) never exercise compared to 13.6% of adults without diabetes.

· The majority of adults with diabetes (51.4%) are obese compared to one out of five adults without diabetes (20.2%).  Additionally, three in ten adults with diabetes (30.1%) 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 Lisa R. Kleiner, Senior Research Associate at lisa@phmc.org.