Diabetes in Texas

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Diabetes in Texas

• Austin R. Kessler
• Texas Diabetes Council/Program

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Texas Diabetes Council
Texas Department of State Health Services
Health care systems
Community-based organizations
Centers for Disease Control and Prevention
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Texas Diabetes Council

• VISION
• Texas Free of Diabetes and its Complications

• MISSION
• Effectively reduce health and economic burdens
  of diabetes in Texas

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TDC Duties

• Develop state plan for diabetes prevention and
  control
• Promote physician and patient education
• Work with public- and private-sector partners
• Advise lawmakers on diabetes issues

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DSHS Diabetes Program
Community Interventions
Surveillance and Evaluation
Health Communications
Health Systems Support
Direct Service state funded
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Program Key Functions

• Surveillance and Evaluation
• Community Interventions
• Health Communications
• Health Systems Support/Improvement
• Link Individuals and Providers to Resources
• Support Council Functions

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Resources FY04

• State 2,896,000
• CDC Diabetes 891,000
• Private 56,000

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Resource Use
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Key Activities

• Surveillance and evaluation
• Standards and algorithms
• Provider education and tools
• Public information

• Eye Disease Detection
• Community-based organizations
• Walk Texas
• School program
• Children at risk

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Surveillance and Evaluation

• Monitor prevalence and risks
• Monitor death rate related to diabetes
• Track health care delivery and preventable
  hospitalization rates
• Guidance in local evaluation
• Inform policy makers and communities

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Behavioral Risk Factor Surveillance System (BRFSS)

• To determine prevalence of diabetes and health
  behaviors of adult Texans.
• Random monthly telephone survey of adults age 18
  and up created by CDC.
• Data is weighted and released annually.
• Limitations
• Self-reported
• Excludes those without phones and
  institutionalized persons.

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15,125,961 2003 Texas Adult Population (Age 20
Years and Older)
Estimated 1,568,203 Adult Texans with Diabetes
(Diagnosed Undiagnosed)
Undiagnosed diabetes estimate based on 1999-2000
NHANES. Diagnosed diabetes estimate based on
Texas BRFSS 2003.
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Age-Adjusted Prevalence of Diabetes Texas vs. US,
BRFSS, 1994-2003
Percent ()
At this time 2003 data for the United States is
unavailable. Source Centers for Disease Control,
Division of Diabetes Translation
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Prevalence of Diabetes in Texas

• African Americans (10.5)
• Hispanics (7.8)
• Non-Hispanic Whites (7.9)
• (Source Texas Behavioral Risk Factor
  Surveillance 2003)

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Risk Factors type 2

• African American, Hispanic, Native American,
  Asian American
• Family history of diabetes
• Overweight (over 20 ideal weight)
• Limited physical exercise
• Age 45 or older
• Gestational diabetes or a baby weighing more than
  9 pounds

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Gestational Diabetes

• Approx 2-5 of pregnancies in
• non-diabetic women
• Risks for newborn
• Risks for mother to develop type 2 diabetes

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Number (estimated) Born in Texas in 2000 at
Lifetime Risk for Diabetes
Number in Thousands
52.5
45.4
31.2
26.7
49.0
40.2
43.3
36.9
Sources Narayan, K.M., et al. (October 8,
2003) "Lifetime Risk for Diabetes Mellitus in
the United States, JAMA,290(14). Birth numbers
based on 2000 population, Texas Department of
Health, Bureau of Vital Statistics
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Projected ethnic distribution of cases adults

• Projected ethnic distribution of diagnosed
  diabetes for adults
• Assumes 1990-2000 rates of net migration
• Source Texas State Data Center, 2004

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Projected ethnic distribution of cases children

• Projected ethnic distribution of diagnosed
  diabetes in children (17 or under)
• Assumes 1990-2000 rates of net migration
• Source Texas State Data Center, 2004

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Complications of diabetes

• Nervous system disease
• Amputations
• Dental disease
• Complications of pregnancy

• Heart disease
• Stroke
• High blood pressure
• Blindness
• Kidney disease

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Co-morbid Conditions
Source Texas BRFSS, 1998-2000
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Costs and Burdens

• US Cost estimates
• Texas Hospitalizations
• Texas Mortality

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Year
Source DIABETES CARE March 200326(3)
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Source DIABETES CARE March 2003 26 (3)
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Projected impact of changing demographic
characteristics on the national cost of diabetes
20022020 (in 2002 billions of dollars)
Source DIABETES CARE March 200326(3)
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Age Adjusted Frequency per 100,000
Source THCIC, Texas Inpatient Hospital
Discharge Data, 2002.
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Dollars (in millions)
Source Texas Hospital Inpatient Discharge Public
Use Data File, 2001 and 2002, Texas Health Care
Information Council.
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Diabetes-related Kidney Disease

• 3,630 new Texas cases of diabetes-related
  end-stage kidney disease (2001)
• State rate 17 per 100,000 population
• Source CDC, US Renal Data System
• 2,601 new cases approved for services by TDH
  Kidney Health (FY 2001)
• Source TDH Bureau of Kidney Health

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DSHS Kidney Health

• 9,422 clients with diabetes (new and ongoing) in
  program
• Diabetes accounts for 53 of clients
• 7,840,538 for wrap-around services (drugs,
  services, travel) for clients with diabetes
• Source TDH Bureau of Kidney Health FY 2001

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Key Activities

• Mobilize community organizations
• Develop public information
• Promote care standards and guides
• Support provider education and tools

• Promote quality clinical care
• Training for schools
• Implement Walk Texas
• Link Persons to Eye Disease Exams

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Mobilize Community Partners

• Fund, train, and provide technical assistance to
  local groups
• CBOs develop comprehensive plans for diabetes
  education and support
• CBOs implement Diabetes Today/
• Communidad en Accion coalition mode
• Develop primary prevention efforts
• Promote system-wide community changes in physical
  activity and nutrition

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Community Diabetes Service Projects
Community Health Center of Lubbock
Dallas Concilio of Hispanic Organizations
Region 4/5 Contractor (TBD)
City of Fort Worth
Tyler
El Paso Diabetes Assoc.
Fayette Memorial Hospital
Migrant Clinicians Network
Houston
La Grange
Uvalde
Harris County Hospital District
Community Health Development, Inc
MEXICO
Gateway Community Health Center Inc
Laredo
Progreso
Migrant Health Promotion Inc.
Migrant Clinicians Network serves multiple areas
in south and west Texas
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Obesity in Texas School-Age Children
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Coordinated Approach to Child Health (CATCH)

• Systems-oriented approach
• Classroom, cafeteria and physical education
• Coordination of
• Health education
• Physical education
• Nutrition services
• Parent involvement

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Health Systems Support

• Promote TDC Standards of Diabetes Care
• Assist Community Health Centers
• Eliminate health disparities

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Diabetes Care Practices,Texas BRFSS, 19992002
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Health Disparities Collaborative (HDC)
To help primary health care practices change to
improve the health care provided to patients and
eliminate health disparities. Began in 1998 and
focused on diabetes. Bureau of Primary Health
Care (BPHC) funded Primary Care
Association/Clinical Network in five regional
clusters. Institute for Healthcare Improvement
(IHI) to develop the infrastructure to support
the Health Disparities Collaborative.
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Texas Association of Community Health Centers
(TACHC)
Primary care association (PCA) for Texas
Members include federally qualified health
centers in the state and other providers
Clients are uninsured and underserved.
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Capacity and Infrastructure Development (CID)
Texas Diabetes Program contract with TACHC

• Improve health status of underserved
• Create capacity and infrastructure to develop and
  promote changes in public primary care systems
  for diabetes care
• Provide clinicians with tools and resources for
  high-quality care, productive environment and
  leadership

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CID Project Clinics Clients with Diabetes

• Gender 63 female
• Age 30-49 (27)
• 50-64 (47) 65-84 (23)
• Ethnicity Hispanic (75) Black (10) White
  (11) other (4)

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CID Clinics Progress

• Original clinic sites
• At least one A1c test (61)
• Two A1c tests (28)
• Average A1c lowered to 8.0
• Self-mgt goals (35)
• Foot exam documented (30)
• Dilated eye exam (17)

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Public Information

• Application of successful primary prevention
  research
• Promote early detection of diabetes
• Promote measures known to control complications

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Prevention of type 2 diabetes

• National campaigns
• Small Steps, Big Rewards
• Paso a Paso
• Community efforts
• Social groups (faith-based, senior centers)
• Worksites
• Schools
• Coordinated school health programs
• Health Care
• Well person check ups

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Prevent, delay, control type 2 diabetes

• Increase Physical Activity
• Prevent or Reduce Overweight
• 5-10 loss of excess weight
• Lower LDL - diet low in saturated fat and
  cholesterol daily activity
• Control Blood Pressure
• Quit Smoking

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Early detection and quality care

• Promote screening at any care visit
• Insurance plan design
• Coverage to include self mgt ed.
• Disease mgt for high risk patients
• www.Diabetesatwork.org
• Chronic care clinical practice model