Diabetes Resource Guide

DIABETES

RESOURCE GUIDE OKLAHOMA AREA TRIBAL EPIDEMIOLOGY CENTER

CONTENTS Suggested Citation......................................................................................1 Introduction...................................................................................................2 Diabetes Mellitus.....................................................................................3-4 Symptoms of Type 2 Diabetes.................................................................5 Diabetes and Sick Days.............................................................................6 Diabetes and Diseases..........................................................................7-8 Managing Type 2 Diabetes.......................................................................9 Morbidity of Diabetes Mellitus in Oklahoma.............................10-11 Mortality of Diabetes Mellitus in Oklahoma...............................12-14 GIS Map of Locations Where National Diabetes Program Is Offered in Kansas...................................................................................... 15 GIS Map of Locations Where National Diabetes Programs Is Offered in Oklahoma................................................................................ 16 GIS Map of Locations Where National Diabetes Programs Is Offered in Texas......................................................................................... 17 References.................................................................................................. 18

Suggested Citation Akbaran, M., Dougherty, T.M., Deen, M. H., & Piatt, J. J. (2019).Diabetes Resource Guide: Morbidity and Mortality in Oklahoma 2010-2015. Oklahoma City, OK: Southern Plains Tribal Health Board Oklahoma Area Tribal Epidemiology Center.

INTRODUCTION The Oklahoma Area Tribal Epidemiology Center (OKTEC) is a division of the Southern Plains Tribal Health Board (SPTHB). The OKTEC receives core funding from the Indian Health Service (IHS) Cooperative Agreement with the IHS Division of Epidemiology and Disease Prevention. OKTEC coverage area includes Kansas, Oklahoma, and Texas and serves 44 federally recognized tribes in that area. As a public health authority, the OKTEC works with area tribes, state agencies, tribal organizations, academic institutions, non-profits, and many other agencies to provide a wide range of resources. The SPTHB and OKTEC promote healthy communities while strengthening all tribal nations; this includes helping prevent or manage the ongoing diabetes epidemic among American Indian/Alaska Native (AI/AN) people.

In 1997, as a result of the diabetes epidemic among AI/AN communities, Congress established the Special Diabetes Program for Indians (SDPI). Through this funding, AI/AN communities could gain access to quality diabetes care using evidence-based practices.

This resource booklet will provide information related to diabetes disease. It contains information about diabetes mellitus, diabetes and sick days, prevention, symptoms of type 2 diabetes, GIS maps of locations where the National Diabetes Prevention Program (NDPP) is offered in Kansas, Oklahoma and Texas, as well as morbidity and mortality of diabetes mellitus in Oklahoma from 2010-2015.

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DIABETES MELLITUS Prediabetes is a condition when blood sugar levels are higher than normal, but it is not high enough for diabetes. In this condition, people are at risk of developing heart disease and type 2 diabetes. Increasing physical activity and eating healthy can prevent getting diabetes. Diabetes develops when blood glucose or blood sugar is elevated in the blood.

According to the National Institutes of Health (NIH), this excess amount of sugar in the blood can cause several health problems, such as nerve damage (diabetic neuropathy), eye problems (retinopathy), kidney disease (diabetic nephropathy), foot problems, low blood glucose (hypoglycemia), gum disease and other dental problems, sexual and bladder problems, heart disease, and stroke.

There are Three Different Kinds of Diabetes Gestational Diabetes

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• Is a condition when a pregnant mother does not have enough insulin to meet the body’s needs. Insulin is a hormone produced by the pancreas that helps glucose in food to be taken from the blood and used by the body for energy.

Type 1 Diabetes • When the body has stopped producing insulin, an individual develops type 1 diabetes or insulin-dependent diabetes. In this case, people with diabetes need to inject insulin or use an insulin pump.

Type 2 Diabetes • Once the body cannot make enough insulin or blood glucose is too high, or if the body cannot use the insulin to control sugar levels in the blood, which is known as an insulin resistance, individuals develop type 2 diabetes or non-insulin dependent diabetes.

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According to the American Diabetes Association (ADA), in the United States (U.S.) diabetes, is an epidemic. In Kansas, 35.5% of the population has prediabetes, or about 749,000 people, and 12% of the adult population or about 282,000 people have diabetes. In Oklahoma, however, 36.9% of the population has prediabetes, or about 1,036,000 Oklahomans, and 14.1% of the adult population or about 446,000 individuals in Oklahoma have diabetes. It is estimated 26,000 Oklahomans are diagnosed with diabetes every year. In Texas, the percentage of prediabetes is higher than Kansas and Oklahoma and it is 37.2% of the population, or about 6,884,000 people. About 14.6% of the adult population or 2,990,000 people in Texas have diabetes.

According to the NIH, in 2015 about 9.4% of the U.S. population, or about 30.3 million people had diabetes. According to the National Diabetes Statistics Report of 2017, the highest prevalence of diagnosed diabetes for both women (15.3%) and men (14.9%) is among AI/AN adults aged 18 years or older based on age adjusted data for 2013-2015 in the U.S. Among all races and ethnicities, AI/ANs had the highest prevalence of diagnosed diabetes (15.1%) with 95% confidence interval (CI) (15.0-15.2) in 2013-2015.

NIH reported in 2015 about 9.4% f the U.S. population, or about 30.3 million people had diabetes 4

SYMPTOMS OF TYPE 2 DIABETES According to the NIH, depending on how high blood sugars are, the signs of Type 2 diabetes can be none, very mild, or severe. The symptoms are as follows: Unexplained Weight Loss Blurred Vision

Numbness of the Limbs

Increased Hunger

Sores That Do Not Heal

Fatigue

Increased Urination

(Feeling very tired most of the time)

Increased Thirst

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DIABETES AND SICK DAYS The Centers for Disease Control and Prevention (CDC) recommends people with diabetes get the flu shot to avoid getting infection. Flu-related infection in people with diabetes is more difficult to manage than in people without the disease and, in some cases, leads to hospitalization. The CDC also recommends the pneumonia vaccine as part of the diabetes management plan to avoid pneumonia complications in people with diabetes. According to the CDC, even though the blood sugar is within the normal range, people with diabetes still should follow these guidelines on sick days:

Guidelines Fever • A fever may be a sign of infection; check your body temperature twice daily.

Weight • Losing weight without trying is a sign of high blood glucose.

Check your weight once a day.

Meals and Hydration • Try to eat as normal and drink extra non-calorie liquids, 4 to 6 ounces every half hour to prevent dehydration.

Glucose Levels • Keep track of the blood glucose test results every four hours, because sickness can affect the blood sugar and make it hard to manage.

Diabetes Medication • Do not stop taking diabetes pills or insulin during sickness.

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DIABETES AND DISEASES Heart Disease, Stroke, and Kidney Disease According to the NIH, by managing blood glucose, blood pressure, cholesterol levels, and by not smoking, individuals can prevent blood vessel damage caused by diabetes that leads to heart disease, stroke, and kidney disease.

Nerve Damage (Diabetic Neuropathy) and Foot Problems Diabetic neuropathy or nerve damage can damage different types of nerves in different parts of the body, such as organs like the heart or feet and limbs. Nerve damage and poor blood flow can lead to serious foot problems or ulcers in people with diabetes. According to the NIH, foot problems such as callus are very common among people with diabetes. With this condition, patients get pain or an infection that prevents them from walking. Foot checkups with a health care team is recommended by the NIH at each doctor visit.

Hypoglycemia (Low Blood Sugar) If blood glucose drops too low, it is called hypoglycemia. According to the NIH, balancing food, taking medicines, engaging in physical activity, following a meal plan, and testing the blood glucose regularly can prevent individuals from getting hypoglycemia. The symptoms of hypoglycemia are • Sweating • Shaking • Dizziness or lightheadedness • Blurred vision • Paleness • Sleepiness or tiredness • Confusion or disorientation

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Gum Disease and Other Dental Problems According to the NIH, infection, gum disease, or dry mouth are problems among people with diabetes. For prevention, individuals should manage blood sugar, brush their teeth twice daily, avoid smoking, and see the dentist at least once a year.

Sexual and Bladder Problems As stated by the NIH, bladder leaks, retained urine, loss of interest in sex, and erectile dysfunction are common bladder and sexual problems in people with diabetes as a result of diabetes damage to blood vessels and nerves. To control symptoms and restore intimacy, people with diabetes can discuss the available treatment with their doctor.

Eye Disease and Other Health Problems Low vision and blindness can occur as a result of eye damage due to diabetes. Individuals should have their eyes checked once a year for a full examination of the back of the eye to prevent retinopathy. As stated by the NIH, depression, some types of cancer, dementia, sleep apnea, and nonalcoholic fatty liver disease (NAFLD) are also linked to diabetes.

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MANAGING TYPE 2 DIABETES

A Healthy Diet for People with Diabetes According to the NIH, people with diabetes can control type 2 diabetes by managing blood glucose, blood pressure, cholesterol, quitting smoking, and lifestyle changes such as the following: • Increasing Physical Activities • Having a Healthy Diet • Limiting Calorie Intake if Overweight • Losing Weight if Overweight or Obese

A Healthy Diet for People with Diabetes • Low in Refined Sugar • Low in Saturated Fat • High in Fiber, Vitamins, & Minerals

MONITORING BLOOD SUGAR The American Diabetes Association (ADA) suggests that A1C level should be less than 7%, and when using the blood glucose meters, the blood sugar before a meal should be 80–130 mg/dl, and it should be less than 180 mg/dl, 1-2 hours after beginning of the meal.

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MORBIDITY OF DIABETES MELLITUS IN OKLAHOMA The OKTEC used all diagnoses for diabetes mellitus-associated hospitalizations data in Oklahoma using the ICD-9 Codes 250 from 2010 to 2015. Figure 1 shows most diabetes mellitus-associated hospitalizations were among those age 65 years and older (39.2%).

Figure 2 indicates that from 2010 through 2015, the largest percentage of diabetes mellitus-associated hospitalizations occurred in the Northeast Region, 44.7%. Associated hospitalizations from diabetes mellitus in the remaining regions ranged from 4.5% in the Northwest Region to 17.2% in the Southeast Region.

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MORBIDITY OF DIABETES MELLITUS IN OKLAHOMA (cont) Figure 3 shows that of the total number of diabetes mellitus-associated hospitalizations among both genders (N=45,929), females experienced a larger percentage of hospitalizations, 54.9% compared to males of 45.1%.

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MORTALITY OF DIABETES MELLITUS IN OKLAHOMA Table 1: The Risk Ratio (RR) of Diabetes Mellitus-Associated Hospitalizations of AI/ANs Versus Non-AI/ANs in Oklahoma by Region Oklahoma Region

Risk Ratio (AI/AN vs. Non-AI/AN)

Lower Limit

Upper Limit

Central

1.395

1.354

1.436

Northeast

1.395

1.374

1.416

Northwest

1.544

1.478

1.614

Southeast

1.529

1.494

1.565

Southwest

1.521

1.478

1.564

Tulsa

1.239

1.206

1.274

Table 1 shows the risk ratio (RR) of diabetes mellitus-associated hospitalizations among AI/ANs versus non-AI/ANs in Oklahoma by region. For the Central Region, AI/ANs are at a 39.5% increased risk of hospitalizations due to diabetes mellitus with the 95% CI (35.4%, 43.6%).

Among all regions in Oklahoma, the Northwest Region, AI/ANs versus non-AI/ANs have the highest increased risk of associated-hospitalizations of 54.4% due to diabetes mellitus with the CI (47.8%-61.4%). However, in the Tulsa Region, the mean estimate of AI/ANs versus non-AI/ANs is 1.239, and it is lower among all other regions in Oklahoma. In Tulsa, AI/ANs are at 23.9% increased risk of hospitalizations due to diabetes mellitus compared to other regions of Oklahoma.

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MORTALITY OF DIABETES MELLITUS IN OKLAHOMA (cont) The OKTEC obtained the diabetes mortality data from OK2Share website, enhanced IHS linked race. Figure 4 indicates Diabetes Mellitus death rate by gender in Oklahoma 2010-2015 among American Indians (AIs) and non-American Indians (non-AIs). The AI male population had higher death rates (47.4%) of mortality from diabetes mellitus when compared to AI female of 42.6% and to the Non-AI male population of 32.4%.

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Figure 5 indicates the age-adjusted death rates of diabetes mellitus among races in Oklahoma by gender from 2010 through 2015. The AI male population had the highest age- adjusted death rates (78.5%) of mortality from diabetes mellitus among all races and genders. The AI female had a higher rate of mortality (58.7%) when compared to the white female population of 21.5%, but had a slightly lower rate of mortality when compared to the black male population of 59.9%.

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GIS MAP OF LOCATIONS WHERE NATION DIABETES PREVENTION PROGRAM IS OFFERED IN KANSAS

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GIS MAP OF LOCATIONS WHERE NATION DIABETES PREVENTION PROGRAM IS OFFERED IN OKLAHOMA

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GIS MAP OF LOCATIONS WHERE NATION DIABETES PREVENTION PROGRAM IS OFFERED IN TEXAS

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REFERENCES 1. American Diabetes Association. www.diabetes.org/. Accessed July 9, 2019 2. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/flu-sick-days.html.

Accessed July 9, 2019.

3. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/data/statistics/statistics-report. html. Accessed July 9, 2019.

4. Indian Health Services. https://www.ihs.gov/sdpi/. Accessed July 3, 2019.

5. National Association of Chronic Disease Directors. https://www. chronicdisease.org/page/GIS. Accessed June 17, 2019.

6. National Indian Health Board. www.nihb.org/sdpi/. Accessed July 3, 2019.

7. NIH, National Institute of Diabetes and Digestive and Kidney Diseases. https://niddk.nih.gov/. Accessed July 9, 2019 8. OK2SHARE. www.health.state.ok.us/. Accessed July 22, 2019.

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Southern Plains Tribal Health Board Oklahoma Area Tribal Epidemiology Center 9705 North Broadway Extension, Suite 200 Oklahoma City, Oklahoma 73114 (405) 652-9200 | info@spthb.org | spthb.org

This resource guide is funded by the Southern Plains Tribal Health Board Oklahoma Area Tribal Epidemiology Center’s cooperative agreement with the Department of Health & Human Services Indian Health Service grant number U1B1IHS0009.