Diabetes & Women’s Health Across the Life Stages & Diabetes Women’s Health Across the Life Stages A Public Health Perspective Beckles & Thompson-Reid U.S DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION & Diabetes Women’s Health Across the Life Stages A Public Health Perspective Gloria L.A Beckles, MBBS, MSc, and Patricia E Thompson-Reid, MAT, MPH Editors U.S DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION For more information, contact CDC Division of Diabetes Translation P O Box 8728 Silver Spring, MD 20910 Phone: Toll-free 1-877-CDC-DIAB (232-3422) Fax: (301) 562-1050 E-Mail: diabetes@cdc.gov Internet: http://www.cdc.gov/diabetes Suggested citation: Beckles GLA, Thompson-Reid PE, editors Diabetes and Women’s Health Across the Life Stages: A Public Health Perspective Atlanta: U.S Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, 2001 Message from Frank Vinicor, MD, MPH Director, CDC Diabetes Program Writing this monograph has been important for the diabetes program at the Centers for Disease Control and Prevention (CDC) The monograph has become much more than a “report” by CDC It has become a model of thought, interaction, and commitment to make a difference in the lives of people—women or men—facing the daily challenges of diabetes We have come to better understand the impact of greater societal forces and policies on the lives of people with diabetes, though individuals and health care providers make their own essential contributions Many cultural, social, organizational, and environmental forces and will facilitate or limit the impact of our individual decisions, and the need to always coordinate science and clinical medicine with programs and policies has become much more obvious to us We (at CDC), along with many partners, have the opportunity to convert the ideas in this monograph into concrete action to assure that efforts to augment programs directed to both the prevention of diabetes and the care of those with the disease will occur These efforts will synergistically blend clinical and public health strategies In the next 12 months, CDC and its primary cosponsors, the American Diabetes Association, the Association of State and Territorial Health Officials, and the American Public Health Association, will convene a national call-to-action meeting to develop and then implement the National Public Health Action Plan for Diabetes and Women Much more effort is required, but with this monograph, the process has begun Our clinical care systems have benefited many Americans Now, with the blending of public health and medical approaches to the prevention of the disease burden associated with diabetes—in this case in women—many more people who face the daily challenges of diabetes can maintain hope Foreword Diabetes has been a serious public health problem for many years Currently an estimated 16 million Americans have diabetes, more than half of them women Why, then, has so little progress been made in reducing the burden of this disabling disease? This provocative question is explored by the authors of Diabetes and Women’s Health Across the Life Stages: A Public Health Perspective Throughout its pages, editors Gloria L.A Beckles and Patricia E Thompson-Reid and their collaborators introduce us to some eye-opening issues and some serious, sobering implications for the health of women There is no better time for this in-depth look at diabetes as a women’s health issue than now, as we begin a technologically advanced new century Old or young, onethird of American women are overweight, and more than one-fourth not participate in any leisure-time physical activity, according to the Third National Health and Nutrition Examination Survey (NHANES III 1988–1994) As a group, American women are aging and growing more obese and less physically active; each of these factors increases their risk for type diabetes Currently, about 20 million are over age 65 By the year 2030, that number is expected to double to 40 million, or roughly in American women Astonishingly, more than million women will be past the age of 85, compared with million men The face of the American population is also changing: by the year 2050, in American women will be of Hispanic heritage, in African American, in 11 Asian American, and in 100 American Indian Non-Hispanic whites will represent barely half of the population of women Currently, the prevalence of diabetes is at least 2–4 times higher among women of color, and if this trend continues, the burden of diabetes could reach unimaginable dimensions As the authors point out, the number of persons diagnosed with diabetes increased fivefold between 1958 and 1997, at a direct cost of over $40 billion and an indirect cost of another $50 billion annually from absenteeism, disability, and premature death These facts carry frustrating, even poignant overtones, because much of the burden of diabetes associated with complications is potentially preventable Although we are well aware of the clinical risks and outcomes of diabetes, this monograph adds a new and important public health dimension to diabetes research by looking at the socioeconomic environment that has contributed to the increase of this disease and the challenges we face as we seek to effectively educate women iii about the behavioral changes necessary for prevention As this document points out, efforts to reach women with prevention messages will not work if their social environment does not support the messages The authors conclude that the same social bias that resulted in women’s health historically being viewed primarily in the context of their reproductive organs may still influence women’s health priorities The document’s uniqueness also lies in its visionary understanding of the changing issues that affect women’s health through their life span Because of this awareness, the document is structured to reflect the different manifestations of diabetes at different stages of a woman’s life, including the threat of type and the emergence of type diabetes in youth, gestational diabetes (seen in up to 5% of pregnancies) among women of childbearing age, and type diabetes as a disease of middle-aged and older women The authors make a powerful argument that more information is needed on how behavioral and social factors interact with biological factors to affect the health of women, particularly those with diabetes or other chronic illnesses Until such research gives us a clearer picture of how diabetes develops over time, health care systems should consider custom-designed prevention and control programs tailored for women and based on local and regional attitudes about health care, differing cultural health beliefs, and available social supports Through the National Diabetes Control Program, the Centers for Disease Control and Prevention collaborates with all 50 states, the District of Columbia, and U.S territories and jurisdictions to provide a mechanism for implementing such programs In the 21st century, the government cannot take on this health care burden alone; diabetes will not receive the concerted effort it deserves without action from both the public and private sectors This monograph is lush with data and easy to read and reference It should quickly become a useful tool for health care professionals, advocates, and educators seeking a leadership role in the fight against diabetes Wanda K Jones, DrPH Deputy Assistant Secretary for Health (Women’s Health) Director, U.S Department of Health and Human Services Office on Women’s Health iv Acknowledgments This report was prepared by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation Contributing Authors Chapters Gloria L.A Beckles, MBBS, MSc, Medical Epidemiologist/Senior Service Fellow, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Jeffrey P Koplan, MD, MPH, Director, Centers for Disease Control and Prevention, Atlanta, Georgia James S Marks, MD, MPH, Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Cynthia Berg, MD, MPH, Medical Officer, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Frank Vinicor, MD, MPH, Director, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Isabella Danel, MD, MPH, Epidemiologist, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Kathy Rufo, MPH, Deputy Director, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Kellie-Ann Ffrench, MA, Department of Psychology, University of Georgia, Athens, Georgia Catherine Hennessey, DrPh, Epidemiologist, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Editors Gloria L.A Beckles, MBBS, MSc, Scientific Editor, Medical Epidemiologist/Senior Service Fellow, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Deanna Hill, MPH, Epidemiologist, Henry Ford Health System, Department of Biostatistics and Research Epidemiology, Detroit, Michigan Patricia E Thompson-Reid, MPH, MAT, Managing Editor, Program Development Consultant, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Georgeanna J Klingensmith, MD, University of Colorado Health Sciences Center, The Barbara Davis Center for Childhood Diabetes, Denver, Colorado v Diabetes and Women’s Health Across the Life Stages: A Public Health Perspective Dawn L Satterfield, RN, MSN, Health Education Specialist, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia JoAnn E Manson, MD, DrPH, Associate Professor, Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts Lily D McNair, PhD, Assistant Professor, Department of Psychology, University of Georgia, Athens, Georgia Angela Green-Phillips, MPA, Chief, Office of Policy and Program Information, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Jill M Norris, MPH, PhD, Assistant Professor, Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver, Colorado Senior Reviewers Diane Rowley, MD, MPH, Associate Director for Science, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Barbara A Bowman, PhD, Associate Director for Policy Studies, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Mary Sabolsi, MD, MPH, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts Carl Caspersen, PhD, Associate Director for Science, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Patricia E Thompson-Reid, MPH, MAT, Program Development Consultant, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Michael M Engelgau, MD, Chief, Epidemiology and Statistics Branch, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Frank Vinicor, MD, MPH, Director, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Anne Fagot-Campagna, MD, PhD, Visiting Scientist, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers or Disease Control and Prevention, Atlanta, Georgia Case Studies Ann Albright, PhD, RD, Director, California Diabetes Control Program, California Department of Health, Sacramento, California H Wayne Giles, MD, PhD, Associate Director for Science, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Ann Kollmeyer, RD, MPH, Chief, Office of Policy and Program Information, Wolf Project, Minnesota Department of Health, Minneapolis, Minnesota vi APPENDIX D AGE-STANDARDIZED PREVALENCE* OF DIAGNOSED DIABETES PER 100 ADULT FEMALE POPULATION, BY STATE— UNITED STATES, 1994–96 VT WA ME MT ND MN OR ID NH MI WI SD NY WY PA IO NE NV IN IL UT OH WV KS AZ OK NM MO NJ DE CO CA CT MA RI KY VA MD NC TN AR SC MS AL GA LA TX FL AK HI 2.790–3.649 3.715–4.206 4.258–4.751 4.863–6.325 *3-year moving average Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, data from the Behavioral Risk Factor Surveillance System Data computed by the Division of Diabetes Translation 185 APPENDIX E 2001 QUICK REFERENCE GUIDE TO THE AMERICAN DIABETES A SSOCIATION’S STANDARDS OF CARE • SMBG: Should be performed as appropriate to meet goals PHYSICAL ASSESSMENT • Visits: Continuing care visits every six months or appropriate to meet patient’s needs and treatment goals • Physical Activity: Review goals at every continuing care visit Conduct comprehensive assessment yearly to include frequency and duration of activity and physical limitations • Blood Pressure: Every continuing care visit Goal is