Texas Business Group on Health

Snapshot of

Key DiabetesTrends Across Texas 2016

++

Prevalence and ScopeQuality of CareEconomic Burden

presents

Diabetes, along with its sibling - Obesity are costly and serious epidemics, that continue to pose significant public health challenges for our health care system, the economy, and employers alike.

Every 19 seconds someone in the U. S., aged 20 years or older, is diagnosed with Diabetes.1,4 Comorbidities with behavioral health conditions and other chronic diseases are numerous and in most cases preventable. Diabetes complications, falls in the top 3 of the highest-cost conditions in Texas.5 Employers, along with the health care stakeholder community and the nation must continue to join forces to battle the social and economic burden of Diabetes and its sibling epidemic - Obesity.

The Texas Business Group on Health (TBGH) is pleased to bring you the 2016 Snapshot of Key Diabetes Trends Across Texas, focusing on the Prevalence, Scope, Quality of Care and the Economic Burden of Diabetes. The Snapshot also highlights Standards of Medical Care and health care resource costs attributable to Type 2 Diabetes for Texas, Dallas, Austin, Fort Worth, Houston and San Antonio, as compared to the nation and includes a Call-To-Action for Employers.

Supported by

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Diabetes:

Prevalence and ScopeA1

A Growing Epidemic1,2,6,9,10,13

A3

Obesity (a major risk factor)

A4

ComplicationsThe risk of heart attack and death from heart disease nearly doubles with Diabetes.1,3

People with Diabetes have a higher risk for many types of cancer (e.g., pancreas, colon, bladder, breast, uterus and liver).8

Diabetes is the leading cause of new cases of blindness among working-age adults.1,3

People with Diabetes are twice as likely to develop depression.1,3

Diabetes is the leading cause of kidney failure or end-stage renal disease (ESRD), requiring dialysis or a transplant.1,3

People with Diabetes have a 50% Higher risk of death.1,2,4

Obesity is linked to the development of diabetes in the U.S. and is also considered a growing epidemic. Obesity is one of the biggest drivers of preventable chronic diseases and healthcare costs in the United States and is also linked to heart disease, hypertension, arthritis, cancer, sleep apnea and many others.

56.2%

85.8%of Texans with Diabetes are Obese, 20146

of Texans with Diabetes are Overweight or Obese, 20146

1 out of every 11 people has Diabetes4

1 out of 4 people do not know they have Diabetes4

1 out of 3 people will develop Diabetes in their lifetime4

DIABETES

2.5 Million5

in Texas

29.1 Million1,2,4

in U.S.

PREDIABETES

More than 1 out of 3 adults has Prediabetes4

9 out of 10 people with Prediabetes do not know they have it4

Within the next 5 years, 15-30% of people with Prediabetes will develop Type 2 Diabetes4

7.1 Million5

in Texas

86 Million1,2,4

in U.S.

A2

Prevalence andIncidence1,5

Obesity; prediabetes; Weight/BMI/Waistline;

Diabetes Complications; Diabetes related Deaths

Direct & Indirect Costs; ER visits, Hospitalizations, Physician Office Visits,

Hospital Outpatient Services; and Workplace

Absenteeism

INCREASING

DECREASING

Physical Activity; Glucose, BP and Cholesterol Control

Self-Monitoring/Compliance & Management

Healthy Eating and Lifestyle; Workplace Productivity

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Diabetes:

Quality of CareB1

OptimalCare ManagementBetter control and management of the A, B, C’s of Diabetes reduces costs and chronic complications.1,2,3

A1c Control

Can reduce microvascular (eye, kidney & nerve) complications by 40%

Blood Pressure Control

Can reduce Heart Disease and Stroke by 33-50% and microvascular (eye, kidney & nerve) complications by 33%

Cholesterol Control (LDL, HDL and Triglycerides)

Can reduce Heart Disease by 20-50%

Preventive Care Practices - Comprehensive Foot Care programs.1, 2, 3, 7

of Texas adults aged ≥18 years with diabetes reported receiving an annual Foot Exam by a healthcare professional, 2014.759%

Candecrease

lower-limbAmputations

RiskAssessments

Foot care education & preventive

therapy

Treatment offoot problems &

referrals to specialists Note: An estimated 43.1 million hospital inpatient days are incurred by people

with Diabetes and 26.4 million days are attributed to Diabetes.

B2

Chronic complications from Diabetes drive uphealthcare costs and put a strain on our healthcare system and resources9

Chronic Complications

Neurological symptoms – 28%

Peripheral vascular disease – 30%

Atherosclerotic cardiovascular disease (ASCVD) – 27%

Diabetic kidney disease complications – 29%

Endocrine complications – 11%

Diabetic retinopathy (Eye) complications – 21%

Other complications (e.g., infections, etc.) -27%NOTE: Percent of Category Expenditures

Hospital inpatient days

Physician office visits

Emergency department visits

Hospital outpatient visits

Outpatient medications and supplies (e.g., eyewear, orthopedic items, hearing devices, prosthesis, bathroom aids, medical equipment, disposable supplies, etc.)

Healthcare Resource/Setting

B3

Testing RatesPercentage of Type 2 Diabetes Patients, by Service, 201410

Tests

A1c

Glucose

Cholesterol

Kidney Function

Eye Exam

Nation

73.90%

86.70%

84.40%

71.40%

69.70%

TX

69.50%

84.10%

80.30%

63.10%

63.80%

DAL

68.80%

84.30%

79.40%

62.50%

62.80%

AUS

78.60%

89.40%

86.40%

67.00%

60.30%

FW

66.20%

81.40%

78.30%

61.90%

64.00%

HOU

68.10%

81.60%

78.40%

61.40%

63.00%

SA

67.60%

83.70%

79.40%

62.80%

65.70%

Texas and top MSAs across the state fell below the nation again in Standards of Medical Care recommended tests, with the exception of Austin on 3 of the 5 tests profiled. This lapse in testing can lead to poor control, sub-optimal care management and costly health complications, increasing the risk of morbidity and mortality in patients with Diabetes.

B4

Diabetes Recommended Tests/Exams1,2,7,11,12

Test/Exam

A1c

Cholesterol(Lipid Profile)

Kidney Function

Eye Exam (Lipid Profile)

Comprehensive Foot Exam

Weight/BMI/Waist

Blood Pressure

Dental Exam

Smoking Cessation(Counseling)

Immunizations:Flu Shot, **HepB (series upon Dx), andif ≥ 65 years Pneumococcal Pneumonia

Every VisitEvery3-6 months Yearly

Yearly or *3-6 months, if abnormal

(6 mos.)

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References: TBGH 2016 Snapshot of Key Diabetes Trends Across Texas

Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. Available from http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed 4/13/2016.

Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Diabetes 2014 Report Card. Available from http://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014.pdf Accessed 4/14/2016.

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. Available from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed 4/12/2016.

Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. CDC: Diabetes Infographic – A Snapshot -Diabetes in the United States. Available from http://www.cdc.gov/diabetes/pubs/statsreport14/prediabetes-infographic.pdf Accessed 4/12/2016.

Texas Department of State Health Services. Chronic Disease Prevention in Texas. Presentation to the Senate Committee on Health and Human Services by Commissioner – John Hellerstedt, MD and Janna Zumbrun, Assistant Commissioner – Div. for Disease Control and Prevention Services. 2/18/2016. Available at http://www.senate.state.tx.us/75r/senate/commit/c610/h2016/021816-DSHS-c1.pdf Accessed 4/14/2016.

Centers for Disease Control and Prevention. Division of Diabetes Translation. U.S. Diabetes Surveillance System. Risk Factors for Complications – Texas Adults with Diabetes, 2014. Available from http://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html. Accessed 4/12/2016.

Centers for Disease Control and Prevention. Division of Diabetes Translation. U.S. Diabetes Surveillance System. Preventive Care Practices – Texas Adults with Diabetes, 2014. Available from http://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html. Accessed 4/12/2016.

American Diabetes Association Checkup America: What You Need to Know: Diabetes & Cancer. Available from http://www.diabetes.org/are-you-at-risk/lower-your-risk/diabetes-and-cancer.html. Accessed 4/14/2016.

Yang, W., Dall, T., Halder, P., Gallo, P., Kowal, S., & Hogan, P. Economic Costs of Diabetes in the US in 2012. Diabetes Care, Volume 36:1033-1046, 2013. American Diabetes Association. Available from http://care.diabetesjournals.org/content/36/4/1033.full. Accessed 4/13/16.

Sanofi U.S. in partnership with Texas Business Group on Health. Texas Type 2 Diabetes Report, 2015, 10th Edition. Managed Care Digest Series ®

Texas Department of State Health Services – Texas Diabetes Council: Diabetes Minimum Practice Recommendations for Children and Adults, 2014. Available from http://www.tdctoolkit.org/wp-content/uploads/2014/05/02MinPracticeRec.pdf. Accessed 4/14/2016.

American Diabetes Association. Standards of Medical Care in Diabetes—2016: Summary of Revisions. Diabetes Care. 2016; 39 (supplement 1): S1-S106. 2016 Available from http://care.diabetesjournals.org/content/39/Supplement_1/S4.full Accessed 4/12/2016.

Cawley J, Rizzo JA, Haas K. Occupation specific Absenteeism Costs Associated with Obesity and Morbid Obesity. Journal of Occupational and Environmental Medicine, 49 (12): 1317–24, 2007. Available at http://stateofobesity.org/healthcare-costs-obesity/ Accessed 4/13/2016.

American Diabetes Association – Common Reasonable Accommodations for Individuals with Diabetes, 2014. Available from http://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/employment-discrimination/reasonable-accommodations-in-the-workplace/common-reasonable-accommodations.html. Accessed 4/14/2016.

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