A Call to Improve Patient and Public Health Outcomes of Diabetes
This issue brief is based on the American Public Health Association Policy Statement No. 20215¹
Summary
Diabetes mellitus is a common disease within the United States and Iowa that has an increasing prevalence. There are many evidence-based public health strategies to help improve population health as it relates to diabetes.
IPHA supports the following actions, endorsed by the American Public Health Association,¹ to improve the public’s health and access to diabetes care:
- Increased access to comprehensive, high-quality care including dental care, vision and eye care, podiatric care, and medical management.
- Increased public education on diabetes, the importance of screening, and prevention of disease and disease progression.
- Increased funding and access to high-quality care for underserved and at-risk populations.
- Continued high-quality, detailed data collection to inform policy and program development.
Health Impact
Diabetes is becoming an increasing cause of morbidity and mortality within the United States. Adults over 50 with diabetes live with disability 1 to 2 years longer and die on average 4.6 years earlier than their adult counterparts without diabetes.² In 2020, diabetes became the 8th leading cause of death among adults.² Risk factors for the disease depend on which type of diabetes one has. Type 1, which typically develops in adolescents, is related to certain genes and family history. Type 2 diabetes is associated with obesity, poor diet, physical inactivity, and smoking. Type 2 diabetes is normally seen as adult onset, but there has been an alarming number of children and teens who have begun to develop the disease.³ There are many long-term harmful sequelae of diabetes, especially when the disease is uncontrolled. These impacts include periodontal disease, kidney disease, foot and ankle disease, and eye disease.²
Public health initiatives have a role in primary, secondary, and tertiary prevention of diabetes mellitus. Programs include a focus on the promotion of lifestyle and nutritional changes and education.² Additionally, an integrated care team approach can be extremely effective in helping prevent progression and sequelae of disease.¹
Health Equity and Minority Impact
Diabetes highlights disparities found in healthcare. The disease is more common among the less educated and those of lower socioeconomic status.² Additionally, racial minorities, including Black, Latino, and American Indians, are diagnosed with diabetes at disproportionate rates.⁴ These minorities additionally have greater burdens of diabetes-related complications.⁴ Members of racial minorities and the less educated were both less likely to receive preventative care practices.²,⁴ This is likely due to barriers to care⁴ or not being adequately educated on diabetes preventive care.²
Iowa Data
In Iowa in 2022, 248,300 people have diabetes,⁵ with a state prevalence of 9.7%.⁶ There were 17,700 new cases of diabetes in Iowa, making up 14% of all cases of diabetes within the state.⁵ 7.3% of Iowans have pre-diabetes,⁵ which is significantly lower than the national average of 33%.² Diabetes costs the state $2 billion in direct medical costs yearly and $646 million in indirect costs.⁵ Additionally, vision loss as a complication of diabetes costs Iowa an estimated $1 billion.⁵
Diet is an essential part of diabetes prevention and is involved in disease progression. In 2021, 14.3% of adults in Iowa could not afford to eat balanced meals within a given month,⁷ with minorities being disproportionately impacted. 58.5% of Iowans report eating less than 1 fruit per day, and 77.0% of Iowans eat less than 1 vegetable per day.⁷ 16,100 Iowans have seen a diabetic nutrition educator within the last year.⁵
Weight and physical activity also play a role in diabetes prevention and progression. 75.3% of Iowans reported 1 or fewer days of leisure physical activity in a given month.⁷ 34.3% of Iowans are overweight, and 36.4% of Iowans are obese.⁷ Iowa currently has 47 CDC-recognized lifestyle change programs in place to combat diabetes, and 3,400 Iowans are currently enrolled in national diabetes prevention programs.⁵
Additional Information
Within the United States, 10.5% of the population has diabetes, with 13% of the adult population being diagnosed with the disease.⁸ The incidence and prevalence of the disease both increase with age, and the prevalence of diabetes has been overall increasing since 1999.⁸ Prior to the COVID-19 pandemic, the incidence of diabetes was beginning to decrease. Specifically, from 2009–2019, there was a decreasing incidence of diabetes for the first time in two decades.² However, since the COVID-19 pandemic, the incidence has begun to increase again.² Importantly, 2.8% of the United States population is not aware they meet diagnostic criteria for diabetes and thus are not receiving treatment.⁸ This makes up an estimated 21.4% of people with diabetes who are unaware they have the disease.⁸
References
- American Public Health Association. (2021, October 26). A Call to Improve Patient and Public Health Outcomes of Diabetes through an Enhanced Integrated Care Approach. American Public Health Association Policy Statement Database.
https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Call-to-Improve-Patient-and-Public-Health-Outcomes-of-Diabetes - Centers for Disease Control and Prevention. (2023, November 14). National Diabetes Statistics Report. Diabetes.
https://www.cdc.gov/diabetes/data/statistics-report/index.html - Centers for Disease Control and Prevention. (2023a, April 18). Type 2 diabetes. Diabetes.
https://www.cdc.gov/diabetes/basics/type2.html - Haw, J. S., Shah, M., Turbow, S., Egeolu, M., & Umpierrez, G. (2021). Diabetes Complications in Racial and Ethnic Minority Populations in the USA. Current Diabetes Reports, 21(1), 2.
https://doi.org/10.1007/s11892-020-01369-x - Centers for Disease Control and Prevention. (2022a, September 15). Iowa Diabetes Profile. State, Local, and National Partner Diabetes Programs.
https://www.cdc.gov/diabetes/programs/stateandlocal/state-diabetes-profiles/iowa.html - Iowa Department of Health and Human Services. (n.d.). Diabetes data. Iowa Public Health Tracking Portal.
https://hhs.iowa.gov/public-health/data/health/diabetes#diabetes-data - Iowa Department of Health and Human Services. (2022). Iowa Behavioral Risk Factor Surveillance System (BRFSS) Brief: 2021 Findings.
https://publications.iowa.gov/43527/1/Iowa_BRFSS_Brief_2021_Survey_Findings.pdf - Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report 2020.
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf