assessing changes in diabetes management and diabetes complications in utah ladene larsen, rn...
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Assessing Changes in Diabetes Management and Diabetes
Complications in Utah
Ladene Larsen, RN
Barbara Larsen, RD, MPH
William Stinner, Ph.D.
Sandra Assasnik, MA
Brenda Ralls, Ph.D.
The Burden of Diabetes
• Diabetes is the 4th leading cause of death from chronic disease
• Diabetes costs the nation over $100 billion annually
• Diabetes increases the risk of heart disease, kidney failure, blindness, and amputation
Effective Diabetes Management Can:
• Reduce blindness by 50%
• Reduce lower-extremity amputation by 50%
• Reduce kidney disease by 50%
• Reduce heart disease and stroke by 25%
Methods
• Surveys targeting Utahns with diabetes were conducted in 1987, 1991, and 1997
• Ages ranged from 3 to 93
• Over 200 respondents were included at each wave of the survey
T o o e l e
M i l l a r d
I r o n S a n J u a n
K a n e
J u a b
B o x E l d e r
U in t a h
E m e r y
G a r f i e l d
G r a n d
U t a h
B e a v e r W a y n e
D u c h e s n e
S e v i e r
S u m m i t
R i c h
C a r b o n
W a s h i n g t o n
C a c h e
S a n p e t e
P i u t e
W a s a t c h
D a v i s
W e b e r
D a g g e t t
S a l t L a k e
T o o e le
M il la r d
Iro n S a n J u a n
K a n e
Ju a b
B o x E ld e r
U in ta h
E m e r y
G a rf ie ld
G ra n d
U t a h
B e av e r W a yn e
D u ch e s n e
S e v ie r
S u m m it
R ich
C a rb o n
W a s h in g to n
C a ch e
S a n p e te
P iu t e
W a s a tc h
D a v is
W e b e r
D a g ge tt
S a lt L a k e
T o o e le
M ill a rd
Ir o n S a n J u a n
K a n e
J u a b
B o x E ld e r
U in ta h
E m e ry
G a r f ie ld
G ra n d
U ta h
B e a v e r W a y n e
D u c h e s n e
S e v i e r
S u m m it
R ic h
C a r b o n
W a s h in g to n
C a c h e
S a n p e te
P i u te
W a s a tc h
D a v i s
W e b e r
D a g g e tt
S a l t L a k e
Decreasing Age at Diagnosis of Diabetes by Gender: Utahns With Diabetes Survey, 1987, 1991 and 1997
50.7
47.3 47.946.5
45.5
43.4
35
40
45
50
55
Per
cent
1987 1991 1997
Year
MalesFemales
Percent of Utahns With Diabetes Who Used
Insulin: 1987-1997
46.6
36.2
36.7
20
30
40
50
60
70
80
1987 1991 1997
Year
Per
cent
Percent of Utahns With DiabetesWho Used Oral Meds: 1987-1997
46.144.6
34.9
20
30
40
50
60
70
80
1987 1991 1997
Year
Per
cent
Percent of Utahns with DiabetesWho Used Both Insulin and Oral Meds: 1987-
1997
10.1
2.3 2.9
0
2
4
6
8
10
12
1987 1991 1997
Insurance Coverage Among Utahns with Diabetes
Percent of Utahns with Diabetes
Who Had Health Insurance: 1987-1997
83.9 84.791.0
0
20
40
60
80
100
1987 1991 1997
Year
Per
cen
t
31.1
35.0
16.431.3
13.7
41.0
0
10
20
30
40
50
60
70
80
1987 1991 1997
Year
Per
cent
Cost of visitVisit not covered
Access to Provider Services Among Utahns with Diabetes Who Were Covered by Insurance: 1987-1997
Complications Among Utahns With Diabetes
Percent of Utahns with Diabetes
with LEAs: 1987-1997
2.9
4.0
0.5
0
2
4
6
1987 1991 1997
Year
Per
cen
t
Percent of Utahns with DiabetesWho Were on Dialysis: 1987-1997
0.5
1.7 1.9
0
1
2
3
1987 1991 1997Year
Per
cent
Percent of Utahns with Diabetes Who Had Diabetic Retinopathy: 1987-1997
14.414.6
10.6
0
5
10
15
20
1987 1991 1997
Year
Perc
en
t
Percent of Utahns with Diabetes Who Were Referred for Dilated Eye Exam: 1987-1997
44.0
21.621.6
0
10
20
30
40
50
1987 1991 1997
Year
Per
cen
t
Percent of Utahns with Diabetes Who Had High Blood Pressure: 1987-1997
52.355.451.8
0
20
40
60
80
1987 1991 1997
Per
cent
Percent of Utahns with DiabetesWith Angina: 1987-1997
12.4 12.2
20.4
0
5
10
15
20
25
1987 1991 1997
Per
cen
t
Percent of Utahns with Diabetes, Who Had High Blood Pressure, by Age, With and Without Diabetes:
Utah Health Status Survey, 1996
14.1
32.9
43.9
2.8
12.917.6
0
10
20
30
40
50
<45 45-64 65+
Per
cen
t
Diabetes
No Diabetes
Percent of Utahns with Diabetes, Who Had High Cholesterol Levels, by Age, With and Without
Diabetes: Utah Health Status Survey, 1996
15.2
27.7 27.6
2.8
12.9
17.6
0
5
10
15
20
25
30
<45 45-64 65+
Per
cen
t
Diabetes
No Diabetes
Percent of Utahns Who Had Cardiovascular Disease, by Age,With and Without Diabetes: Utah Health Status Survey, 1996
36.6
4.92.9
15.4
0.3
16.2
0
10
20
30
40
Less than 45 45-64 65 and overAge
Per
cent
DiabetesNo diabetes
Provider Care Among Utahns With Diabetes
Primary Care Providers for Utahns with Diabetes: Urban and Rural Areas, 1997
Don't Know10%
Other11%
General /Family Practice
33%
Iternal Medicine
46%
Don't Know11%
Other5%
General/Family Practice
52%
Internal Medicine
32%
Urban Rural
Patient-Doctor Communication Patterns at Routine Visits for Utahns with Diabetes: 1987-1997
35.537.9
47.0
58.5
36.7
54.4
71.2
57.360.6
48.2
34.8
30
40
50
60
70
80
1987 1991 1997
Year
Per
cen
t
Discussed Complications
Joint Goal Setting
Doctor Discussed Records
Patients Asked Questions
Percent of Utahns with Diabetes Who Received Provider Services During Routine Visits: 1987-1997
52.655.8
44.9
33.0
44.6
20
30
40
50
60
70
80
1987 1991 1997
Year
Per
cent
Doctor Checked Feet
Doctor Checked HbA1c
Differences at Routine Check-ups Between General or Family Practice Physicians and Internists: 1997
76.2
44.3
77.7
63.1
0
20
40
60
80
100
Refer for Eye Exam Referral Check Feet
Per
cent
General/Family Practice
Internal Medicine
Differences in Doctor-Patient Communication Between General or Family Practice Physicians and
Internists: 1997
37.9
54.5
41.6
55.6
38.7
68.658.4
88.4
0
20
40
60
80
100
DiscussComplications
Set Goals Ask Questions Discuss Records
Per
cent
General/Family Practice
Internal Medicine
Self-Management Among Utahns With Diabetes
Percent of Utahns with Diabetes Who Checked Own Feet and Glucose: 1987-1997
21.6
32.634.834.2
50.6
65.8
0
10
20
30
40
50
60
70
Check feet Check glucose
Per
cen
t
1987
1991
1997
Percent of Utahns with Diabetes Who Used Meal Plan 1987-1997
63.269.764.2
40
50
60
70
80
1987 1991 1997
Year
Per
cent
Percent of Utahns with Diabetes
Who Exercised: 1987-1997
58.8
40.433.0
20
40
60
80
100
1987 1991 1997
Year
Per
cent
Percent of Utahns with Diabetes Who Smoked: 1987-1997
8.47.3
8.7
0
2
4
6
8
10
1987 1991 1997
Per
cen
t
Percent of Utahns with Diabetes Who Were Obese (BMI>=30 kg/m2): 1987-1997
49.8
28.924.8
0
10
20
30
40
50
60
1987 1991 1997
Year
Per
cent
Conclusions:
• Age of diagnosis of diabetes is declining
• Use of pharmaceuticals is increasing
• Insurance coverage is increasing
• Prevalence of serious complications is increasing
• Quality of provider care is improving
• Patients are becoming more responsible for their own management of diabetes
Implications
• We need to provide better information on diabetes management protocol to general and family practitioners
• Increasing obesity may be the greatest obstruction to seeing reductions in secondary complications from diabetes and may be off-setting all the other gains made
“Diabetes is a disease about which we can do a great deal, but only when those affected are informed and empowered to take the kind of control of this disease that is now possible.”
Dr. James R. Gavin III, MD
Chair, African-American Program
Contact Information:
Brenda Ralls
Utah Diabetes Control Program
Bureau of Health Promotion
Utah Department of Health
Salt Lake City, UT 84114-2107
(801) 538-6083