It is estimated that 72,000 to 100,000 people currently have diabetes in Hawaii, of which 25,000 or more remain undiagnosed.
Native Hawaiians, Filipinos, and Japanese have higher rates of diabetes than Whites.
Prevalence rates of diabetes are similar across all of Hawaiia counties.
Native Hawaiians have the highest diabetes mortality rates when compared with the other major ethnic groups. Whites have the lowest diabetes mortality rates.
Lower educational attainment is associated with higher diabetes prevalence and mortality.
Obesity rates are significantly higher among adults with diabetes when compared with adults without diabetes.
Adults with diabetes are less likely to be current smokers and are more likely to be former smokers when compared with adults without diabetes.
Adults with diabetes are more likely to eat at least 5 servings of fruits/vegetables when compared with adults without diabetes.
Adults with diabetes are more likely to receive their immunization for flu and pneumonia when compared with adults without diabetes.
Hawaii has a higher incidence and prevalence rate of patients with end-stage renal disease (ESRD) on kidney dialysis when compared with the national average.
Almost 60% of patients receiving kidney dialysis for ESRD have a primary diagnosis of diabetes.
What is Diabetes Mellitus
Diabetes mellitus is a group of metabolic diseases characterized by high levels of blood glucose (blood sugar). In a person with diabetes, the normal use of food for energy is disrupted because of defects in insulin production, insulin action, or both. Insulin is a hormone which assists with the uptake of glucose into the body's cells. When insulin defects are present, the normal pathway of energy production is disrupted and high blood glucose levels result.
The Centers for Disease Control and Prevention (CDC) estimates that 6.3% of the population, or 18.2 million people (all ages), have diabetes in the United States.
Of these 18.2 million people, almost a third (5.2 million) do not know they have diabetes. Because uncontrolled, unmanaged diabetes is associated with the development of numerous complications, it is the 5.2 million undiagnosed indi- viduals who are particularly at risk for experiencing these associated conditions.
Given that many diabetes complications are preventable, the monies spent to treat this disease are astounding.
Cost studies funded by the American Diabetes Association estimate the total direct and indirect costs of diabetes in this country to be as high as $132 billion ($92 billion in direct medical costs).
Risk for diabetes is determined by certain factors, including genetic, physiologi- cal, and behavioral.
Certain ethnic groups have higher rates of diabetes, sug- gesting a genetic predisposition to the disease. Age also plays a major role in diabetes prevalence.
The CDC estimates that nearly 1 in 5 adults over the age of 65 years has diabetes. Furthermore, nearly 80% of diabetes is diagnosed in over- weight and obese individuals, suggesting a strong link between lifestyle behav- iors and the development of diabetes. Physical inactivity and poor diet are cru- cial factors then in the prevention of the disease.
While not all risk factors are modifiable, those that are contribute greatly to the high prevalence of diabetes and provide the key to public health efforts aimed at reducing diabetes preva- lence.
Uncontrolled diabetes is associated with serious complications and premature death; however, much of this burden could be prevented with early detection, improved delivery of care, and better education on diabetes self-management.
The following are examples of diabetes-related complications that could be pre- vented or reduced:
Cardiovascular disease. Adults with diabetes are two to four times more likely to die of heart disease and stroke, which together cause about 65% of deaths among people with diabetes. These deaths could be reduced by 30% with improved care to control blood pressure, blood glucose, and blood cholesterol levels.
Eye disease and blindness. Diabetes is the leading cause of new cases of blind- ness among adults aged 20 Diabetic retinopathy accounts for approximately 12,000-24,000 new cases of blindness each year. Regular eye exams and timely treatment could prevent up to 90% of diabetes-related blindness; however, only 64.2% of people with diabetes received annual dilated eye exams in 2002.
Kidney disease. Diabetes is the leading cause of end-stage renal disease (ESRD). Each year, over 40,000 people with diabetes develop kidney failure, totaling more than 100,000 people treated for this condition. Treatment to better control blood pressure and blood glucose levels could reduce diabetes-related kidney failure by about 50%.
Amputations. Between 60% and 70% of people with diabetes have mild to severe forms of nervous system damage, contributing to lower-extremity ampu- tation risk. Vascular diseases associated with diabetes increases this risk further.
In fact, about 82,000 non-traumatic lower-extremity amputations of the leg, foot, or toe are performed annually among people with diabetes. Foot care programs that include regular examinations and patient education could prevent up to 85% of these amputations.
Pregnancy complications. About 18,000 women with preexisting diabetes and about 135,000 women with gestational diabetes give birth each year. These women and their babies have an increased risk for serious complications such as stillbirths, congenital malformations, and the need for cesarean sections.
Poorly controlled diabetes prior to conception and during the first trimester is associated with major birth defects in 5%-10% of diabetic pregnancies. Moreover, 15%-20% of pregnancies in mothers with poorly controlled diabetes are spontaneously aborted. Finally, poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to the mother and the child. Women with gestational diabetes and their babies are also at higher risk of becoming obese and developing diabetes later in life. These risks can be reduced with screenings and diabetes care before, dur- ing, and after pregnancy.
Flu- and pneumonia-related deaths. Each year, 10,000–30,000 people with diabetes die of complications from flu or pneumonia. They are roughly three times more likely to die of these complications than people without diabetes; however, only 55% of people with diabetes get an annual flu shot.
The aim of this document is straightforward: to provide insight on the burden and distribution of diabetes among Hawaii�'s residents, allowing local communities to focus their resources and attention where it is most needed. To that end, this report provides pertinent and current information on the prevalence of diabetes; diabetes mortality; diabetes complications (eye, foot, kidney); diabetes preventive care practices; and the relationship between diabetes and general health status, risk factors (obesity, smoking), and health/lifestyle behaviors.
Hawaii Diabetes Report, 2004. Hawaii State Department of Health. Honolulu, Hawaii