Diabetes (Diagnosed) Prevalence

Why Is This Important?

Diabetes and prediabetes are conditions on a continuum marked by blood glucose (blood sugar) levels that are higher than normal due to defects in insulin production, insulin action, or both. Insulin is a hormone needed to absorb and use glucose as fuel for the body's cells. Diabetes can lower life expectancy and increase the risk of heart disease. It is the leading cause of kidney failure, lower limb amputation, and adult-onset blindness. People with prediabetes have blood glucose levels higher than normal, but not high enough to be diagnosed as diabetes. They're more likely to develop diabetes, heart disease, and stroke. Type II Diabetes and its complications can often be prevented or delayed. The great majority of those diagnosed with diabetes are diagnosed with Type II. Proper management of all forms of diabetes can prevent or delay complications. People who are diagnosed with diabetes or prediabetes need to learn about their condition and build the skills and confidence necessary to successfully take care of themselves, with the help of their health care team and community resources. About one-quarter of people with diabetes don't know they have it, and most people with prediabetes don't know they have it. Unfortunately, people who are undiagnosed can't take steps to manage their condition. Data in this Profile are only about diagnosed diabetes prevalence, Type II representing the great majority of all cases..

Definition

Diabetes prevalence is the estimated percentage of adult New Mexicans 18 years and older with diagnosed diabetes. Age-adjusted to U.S. 2000 population (except for rates by age group).

Data Sources

• Behavioral Risk Factor Surveillance System Survey Data, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, together with New Mexico Department of Health, Injury and Behavioral Epidemiology Bureau.
  (https://www.nmhealth.org/about/erd/ibeb/brfss/)
• U.S. data source: Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion Chronic Disease Indicators, Behavioral Risk Factor Surveillance System (BRFSS) Data.
  (https://www.cdc.gov/cdi/)

How the Measure is Calculated

How Are We Doing?

In recent years, the prevalence of diagnosed diabetes has been about twice that of twenty years ago. This is true in NM and the U.S. In 1995, the U.S. age-adjusted prevalence of diagnosed diabetes among adults was 4.6% and that of NM was 5.8%. By 2020, the age-adjusted prevalence estimates were 10.1% (2020 CDC BRFSS National Data Set) and 11.2%, respectively. Since 2011, the NM age-adjusted prevalence of diagnosed diabetes has remained relatively stable between 9.6% and 11.4%, with statistically significant differences only between the years 2011 and 2012 and the year 2018. There was no statistically significant difference between other years. Diagnosed diabetes is associated with age. The prevalence of diagnosed diabetes is higher in older age groups. This does not necessarily mean that age itself is a cause of diabetes. In 2020, within each age group, there was no statistically significant difference in the prevalence of diagnosed diabetes by gender. The prevalence of diagnosed diabetes was very low in the youngest age groups and greatest in the older age groups, with over twenty-two percent of women and nearly twenty-five percent of men age 65 or older having been diagnosed. The aging of the state's population helps drive the increasing prevalence of diabetes. In New Mexico, the population of individuals 55 and older has grown from 27% of all adults in 1990 to 39% of all adults in 2017 and 40% in 2019 and 2020. Prevalence by race/ethnicity: Disparities by race/ethnicity remain. The 3-year (2018-2020) age-adjusted prevalence of diagnosed diabetes was highest among American Indian/Alaska Native adults, 19.2%, and rate was statistically significantly higher than that of all other Race/Ethnic groups with the exception of that of Black/African American adults (15.2%), and was nearly three times the rate of white adults (7.3%). The prevalence rates among Black/African American and Hispanic adults were similar and both were statistically significantly higher than the white rate, and twice the white rate. While the rate for Asian/NHOPI adults was similar to that of white adults, small sample size precluded effective comparison of this rate to those of other groups, even using three years of combined data. Prevalence by race/ethnicity and sex: Within each Race/Ethnic group, the rates for males and females were statistically similar. Household Income: Income and wealth influence the health of communities and individuals. Diabetes prevalence was statistically significantly higher among the two lowest income categories than the three higher income categories. The prevalence of diagnosed diabetes was statistically significantly lowest among adults living in households with an annual income of $75,000 or more. The rate of diagnosed diabetes in the lowest income category was two and a half times that of the highest income category. County rates: County rates: In 2018-2020, three county rates were statistically significantly lower than the statewide age-adjusted prevalence rate of 11.3%: Los Alamos, Catron, and Santa Fe. The rates of five counties were statistically significantly higher than that of the state: McKinley, Cibola, Luna, Rio Arriba, San Juan. The rates for De Baca, Harding, and Hidalgo counties were statistically highly unreliable, and so are not presented. Urban and Rural: The rate for Mixed Urban/Rural areas were statistically significantly higher than that of rural and metro areas.

How Do We Compare With the U.S.?

Generally, both New Mexico and the U.S. prevalence have remained similar since the mid-1990s. The graph shows trends of increasing prevalence since 2000 for NM and the US. Although the recent New Mexico rates appear to be slightly higher, the NM and US rates are statistically similar.

What Is Being Done?

The NM Department of Health Diabetes Prevention and Control Program (DPCP) works with health care providers and community partners, agencies and coalitions to provide multiple diabetes prevention and management services and programs. Services and programs include: professional development trainings and resources for diabetes prevention and management; the National Diabetes Prevention Program (National DPP), a proven community-based physical activity and nutrition intervention to prevent or delay diabetes in persons at high risk; community resources to help people manage their diabetes through skill building, such as the Chronic Disease Self-Management and Diabetes Self-Management Education Programs; Kitchen Creations cooking schools; and health system disease management interventions that improve blood glucose, blood pressure, and cholesterol. The DPCP provides education, information, and resources about prediabetes and diabetes, particularly to health care providers, to increase screening, testing and referral to prevention and management programs. This includes a centralized referral and data system that helps providers easily make referrals to the above programs. Various partners support improvements and offer resources so people at risk for or diagnosed with diabetes can be learn valuable physical activity and dietary practices to reduce risk of development of diabetes or to better manage diabetes. Both are essential components of effective population-based diabetes prevention and control. The DPCP consults with populations that are disproportionately affected by diabetes and/or those that serve them to develop programs and services that are culturally appropriate for these populations.

Evidence-based Practices

Diabetes and its complications can be prevented, delayed and/or managed through participation in evidence-based programs, including the National Diabetes Prevention Program's Lifestyle Change Program (provided in a clinical, community, or web-based setting), the Diabetes Self-Management Education Program (provided in a community or web-based setting), and Diabetes Self-Management Education and Support programs (usually provided in a clinical setting). Engaging New Mexicans at high risk of diabetes with evidence-based prevention and management programs is proven to improve health outcomes and reduce the burden of diabetes including mortality. The following New Mexico Department of Health activities are in alignment with Centers for Disease Control and Prevention guidelines and best practices for diabetes control as recommended by the American Diabetes Association, The American Medical Association and the Association for Diabetes Care and Education Specialists: 1. Increase utilization of the National Diabetes Prevention Program's Lifestyle Change Program to prevent or delay the onset of type 2 diabetes among people at high risk by raising awareness about prediabetes, increasing Lifestyle Change Program delivery sites, facilitating the screening, testing and referral of eligible adults at high risk for diabetes to evidence-based programs, and increasing the participation of priority populations in Lifestyle Change Programs among Native American, Rural, Spanish-speaking and people experiencing disabilities or experiencing overweight/obesity. 2. Increase access to sustainable self-management education and support services, including Diabetes Self-Management Education Programs and Diabetes Self-Management Education and Support Programs to improve control of A1C, blood pressure, and cholesterol, by supporting delivery sites with resources to sustain programs, investing in referral systems to connect individuals from priority populations to programs and developing messaging and materials to reach diverse populations with culturally-relevant health promotion and outreach. 3. Implement evidence-based health systems interventions that support high-risk adults to prevent or manage diabetes and related chronic conditions, and help New Mexicans improve control of their A1C, blood pressure, and cholesterol. Health system interventions include initiating bi-directional referrals through electronic health records, the promoting utilization of A1C standing orders, expanding team-based care approaches to include Community Health Workers and creating workgroups with statewide clinical partners to provide trainings and technical assistance to implement health system interventions. 4 Identify and plan quality improvement activities with healthcare organizations that are working to improve health outcomes for people with and at risk for diabetes. Support healthcare organizations to improve quality of care through use of the Planned Care Model, Patient Centered Medical Home, and Electronic Health Record. Within these organizations, support policy and protocol implementation that institutionalize and help sustain quality care improvements. 5. Promote the sustainability of Community Health Workers (CHWs) and Pharmacists involved in providing diabetes prevention, diabetes management and Medication Therapy Management services. 6. Indirectly support Nicotine Cessation programs.

Other Objectives

There are 15 Healthy People 2030 objectives for diabetes. Most Diabetes objectives are about essential screening (vision, kidney, A1C, foot exams, for example), and self-management behaviors among those with diagnosed diabetes. (https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes)

Available Services

- The Paths to Health New Mexico platform is an initiative that includes several prevention and self-management programs. These programs are designed to help adults gain the skills and confidence they need to better prevent or manage chronic health conditions or injuries. These programs have been proven to work and to improve quality of life. For more information, visit Home - Paths to Health NM at https://www.pathstohealthnm.org/. - Technical assistance to clinics and primary care providers to implement population-based strategies that support system changes that improve health outcomes (e.g. A1C, blood pressure, LDL cholesterol and smoking cessation) for New Mexico's most vulnerable populations. - Support for community-based prevention and management initiatives such as the National Diabetes Prevention Program, Diabetes and Chronic Disease Self-Management Programs, and Kitchen Creations cooking schools, for people with diabetes. - Analysis, interpretation, and dissemination of data on prediabetes, diabetes, cardiovascular disease, demographics, health behaviors, and access to health care. - Online training modules focused on chronic disease, high blood pressure, and high cholesterol are offered at no charge to New Mexico residents. All trainings are offered in English and Spanish with an opportunity to receive CEU's for successful completion. - Diabetes education and outreach in areas that are underserved or identified as priority populations. For more information on programs or services provided by the NM Department of Health, Diabetes Prevention and Control Program, go to https://www.nmhealth.org/about/phd/pchb/dpcp/.

More Resources

NM Department of Health, Diabetes Prevention and Control Program, go to https://www.nmhealth.org/about/phd/pchb/dpcp/. CDC main diabetes webpage: https://www.cdc.gov/diabetes/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdiabetes%2Findex.htm National Diabetes Prevention Program: https://www.cdc.gov/diabetes/prevention/Index.html Evidence-based lifestyle interventions for preventing type 2 diabetes for communities https://www.cdc.gov/diabetes/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdiabetes%2Findex.htm 1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html 2. Diabetes Report Card: https://www.cdc.gov/diabetes/library/reports/reportcard.html Fact Sheets on Physical Activity: www.cdc.gov/nccdphp/sgr/fact.htm Diabetes Data and Trends: https://www.cdc.gov/diabetes/data/index.html 3. Guide To Community Preventive Services [information on community-level evidence-based practices]: Diabetes State Burden Toolkit: https://nccd.cdc.gov/Toolkit/DiabetesBurden National Diabetes Education Program www.ndep.nih.gov/ US Preventive Health Task Force (clinical preventive services) https://www.ncbi.nlm.nih.gov/books/NBK115115/?term=Preventive%20Health%20Task%20force 4. American Diabetes Association: https://www.diabetes.org/ 5. American Diabetes Association 2021 Standards of Care: https://professional.diabetes.org/content-page/practice-guidelines-resources