Diabetes In The United States
The Centers for Disease Control and Prevention estimates that 29.1 million Americans (9.3%) have diabetes, of which 8.1 million are undiagnosed. Additionally, 79 million (38%) Americans age 20 and over have prediabetes, a condition where blood sugar levels are abnormally high. If the current trends continue one in three U.S. adults will have diabetes by 2050.
Diabetes is a chronic disease that can affect many parts of the body and is associated with serious complications such as, heart disease and stroke, blindness, kidney failure, and lower-limb amputation. The total cost of diabetes care in the United States is $245 billion annually. Medical expenditures for individuals with diabetes are 2.3 times higher than those without the diabetes, and account for $176 billion. Indirect costs due to disability, work loss, and premature death account for $69 billion.
Diabetes In Pennsylvania
According to the American Diabetes Association, diabetes was the seventh leading cause of death in Pennsylvania in 2014, and every year 78,000 Pennsylvanians are diagnosed with diabetes. It is estimated 1,348,305 (12.1%) Pennsylvanians have been told they have diabetes and an additional 325,000 have diabetes but have not been diagnosed. 3,505,000 (35.8%) adults in Pennsylvania have pre-diabetes. Pennsylvania adults ages 65 and older have a significantly higher incidence of diabetes.
When Miriam Stitt of Pottstown, PA was diagnosed with type 2 diabetes her family decided they needed to do something to help her manage her condition. Her daughters saw an advertisement for the Dining with Diabetes class in the local paper and told their brothers about it. They all signed up for the class and attended the sessions together. Not only did the information help Miriam and her children learn about managing her diabetes, but Carl, also a type 2 diabetic, learned valuable lifestyle modification tips that he can put into practice.
The Burden of Diabetes in Pennsylvania report noted that diabetes accounted for an estimated $13.4 billion in expenses in 2012, with $10.2 billion in direct medical expenses and another $3.2 billion in indirect costs. Although there has been a decrease in the incidence of Type I diabetes in Pennsylvania, the incidence of Type 2 continues to rise, and approximately 90% of people with diabetes have Type 2. According to The Pennsylvania Diabetes Fact Sheet 2013, the number of hospitalizations where diabetes was the principal diagnosis rose by almost 11% between 2009-2013.
The CDC estimates that only 50 to 60% of adults with diabetes in Pennsylvania have attended a diabetes self-management class. Additionally, over 35% are physically inactive, more than 85% are overweight or obese, greater than 65% have high blood pressure, and over 55% have elevated cholesterol levels. The Pennsylvania Diabetes Prevention and Control Program, in collaboration with the Pennsylvania Diabetes Action Plan, identified several key indicators necessary to address risk factors and complications as defined by Healthy People 2010. At the top of the list is the goal to increase the number of persons with diabetes who receive diabetes education.
Dining with Diabetes is a community-based education program offered by Penn State Extension in 46 rural, suburban, and urban Pennsylvania counties offering a total of 95 new diabetes education programs in 2015. With funding provided by the Centers for Medicare & Medicaid Innovation grant over 1184 Medicare and Medicaid beneficiaries and those from low income/uninsured populations were reached by the program. Extension educators teach a series of four classes, plus a follow-up class where a total of 2880 individuals have participated in the program which focuses on:
- Understanding important biomarker numbers and information to improve self-management
- Healthy food preparation and menu planning
- Benefits of physical activity including ideas for increasing the frequency and level of activity
Adults with Type 2 diabetes, pre-diabetes or who are at risk for developing diabetes and family members, including those with limited access to diabetes education programs are considered to be the primary target population for Dining with Diabetes.
- 50% of participants experienced an improvement in their HbA1C readings and 59% of participants experienced improvements in their blood pressure readings.
- Upon exiting the program, returning participants increase their frequency of days exercised per week from 2.9 to 3.4 days per week, a 17% increase
- 38% of participants increased their knowledge and skill based ability to explain their A1C and blood pressure outcomes
- An increase to 65% of participants (compared to 58% at baseline) strongly agree that diabetes is a serious condition
- An increase to 67% of participants (compared to 57% at baseline) felt confident that they could keep their diabetes under control
- 33% of participants increased the number of days on which they ate a variety of fruit and vegetables
- Four out of five participants (86%) were confident they could explain their A1C results "somewhat well" or "very well" compared to three out of five (66%) at baseline
- 67% of participants evaluated in a follow up and who implemented and/or adopted practices taught by the program
According to the CDC, research indicates that improved control of LDL blood lipids can reduce cardiovascular complications by 20-50%. Controlling blood pressure can also reduce cardiovascular disease by 33-50%. For every 10mmHg reduced in systolic blood pressure, diabetes related complications are reduced by 12%.
Public and Private Benefits
The overall public value of the Dining with Diabetes program is to reduce the incidence of medical complications related to poor blood glucose control and the resulting health care costs, as well as minimize the economic implications associated with this disease and its complications. Diabetes community education programs reduce the risk of diabetes by 58%.
The care of diabetes presents significant economic challenges as well as a significant burden on the healthcare system in Pennsylvania. This, coupled with the quality of life issues for people affected by the disease, reveals the intense public value that the Dining with Diabetes program can have across the state.
- United States Department of Agriculture,
- National Institute of Food & Agriculture,
- Pottstown Area Health & Wellness Foundation,
- Saint Mary's Medical Center Community Health Grant
This program was made possible in part by Grant number 1C1CMS3301021 from the Department of Health and Human Services, Center for Medicare and Medicaid Services.
The contents of this program are solely the responsibility of the authors and have not been approved by the department of health and human services, centers for Medicare and Medicaid services. 12/15