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Michelle D. Owens-Gary, PhD
Behavioral Scientist
The National Public Health Initiative on Diabetes and Women’s Health: An Overview
Division of Diabetes Translation
NCCDPHP
Presentation Outline
Highlight diabetes and women’s health statistics
Discuss the formation of the National Public Health Initiative on Diabetes and Women’s Health
Provide examples of the Initiative’s efforts to address diabetes and women’s health issues
Discuss action steps needed to further our work on diabetes and women’s health
Diabetes Statistics
Almost 26 million Americans (8.3%) have diabetes
Women: 12.6 million have diabetes
Major cause of heart disease and stroke
7th leading cause of death in the United States
2007: Diabetes cost about $174 billion $116 billion - direct medical costs
$58 billion - indirect costs (disability, work loss, premature mortality)
Projected trends in prevalence of diagnosed DM among women by age, 2000 to 2050
0
5
10
15
20
2000 2005 2010 2025 2050
Pre
vale
nce, p
erc
en
t
0-44 45-64 65-74 75+
Boyle JP, et al. Diabetes Care 2001
Year
Percentage of females among projected cases of diagnosed DM by age, 2000-2025
0 25 50 75
0-44
45-64
65-74
75+
Ag
e, years
Percent
2000
2010
2025
Boyle JP, et al.Diabetes Care, 2001
Goals: National Public Health Initiative on Diabetes and Women’s Health
• Garner attention of policymakers, health professionals, public health community, women’s health advocates, and general public
• Develop priority strategies, policies, and research
• Unite partners for diabetes prevention and control
• Empower women to adopt prevention strategies
Diabetes and Women’s Health Across the Life Stages: A Public Health
Perspective
Strategy Areas of the Action Plan
• Advocacy and Policy
• Services and Programs
• Communication and Education
• Research and Surveillance
Ten Major Steps to Action: The Recommendations
1. Encourage and support diabetes prevention and control programs
2. Expand community-based health promotion
3. Strengthen advocacy
4. Fortify community programs
Ten Major Steps to Action: The Recommendations
5. Expand population-based surveillance
6. Educate community leaders
7. Encourage risk assessments, quality care in health care settings
8. Ensure access to quality services
Ten Major Steps to Action: The Recommendations
9. Encourage health care coverage
10. Conduct public health research
Examples of our Efforts— Advocacy/Policy: National Action Plan
• Strengthen advocacy on behalf of women with or at risk for diabetes
– Educate key stakeholders and consumers • 2008 Congressional briefing sponsored by ADA, APHA
– ADA, APHA support of GeDi (Gestational Diabetes) Bill
Examples of Our Efforts—Health Promotion and Quality of Care
• The National Association of Chronic Disease Directors/Women’s Health Council:
– Developed and disseminated an online campaign to promote awareness of modifiable risk (e.g., physical activity, weight loss) factors to prevent or delay diabetes among women • http://www.chronicdisease.org
– Developed a diabetes/depression Web page with mini-grants to 3 states
– Conducting a gestational diabetes validation project
Diabetes and Depression
• States developed and disseminated diabetes and depression prevention messages
• States also conducted workshops educating health care providers and consumers about the co-existence of diabetes and depression – Resources: NDEP DiabetesatWork Web page on
diabetes and depression—www.diabetesatwork.org
– Women’s Health Week: Podcast on diabetes, depression, and older women—www.cdc.gov/podcasts
Support DPCPs Services and Programs
Advocacy/Policy Communication and Education
Surveillance Promotion of Quality Care
AHRQ – CDC Collaboration
Report: Women with Diabetes: Quality of Care
• Examines quality of health care in the US for women with and without diagnosed diabetes
• Data Sources: Medical Expenditure Panel Survey, National Health and Nutrition Examination Survey, National Health Interview Survey
Report: Women with Diabetes: Quality of Care
• Report includes measures of
– access to health care,
– General health and well-being
– Diabetes-specific preventive care
– Cancer-specific preventive care
– Immunization
– Other complications
Highlights: Women with Diabetes: Quality of Care
• Access to Care:
– Women with diagnosed diabetes were significantly more likely than women without diabetes to have access to care
– Women under age 65 with diagnosed diabetes were significantly more likely than those without diabetes to have only public insurance
Highlights: Women with Diabetes: Quality of Care
– Women with diagnosed diabetes were significantly more likely than women without diabetes to have reported an emergency room visit in the past year.
• Preventive Care
– Women with diagnosed diabetes were significantly less likely than women without diabetes to have had a dental visit in past year.
Highlights: Women with Diabetes: Quality of Care
– Women with diagnosed diabetes were significantly more likely than women without diabetes to have received influenza and pneumococcal vaccinations.
• Yet, among women under 65, only 40% had been immunized against influenza and fewer than 40% for pneumococcal.
Report: Women at High Risk for Diabetes: Access and Quality of
Care • Examines quality of preventive health care received by
US women at high risk and not at high risk for diabetes
• Data Source: NHANES
• Measures:
– Access to health care
– General health and well-being
– Preventive care and behaviors
Highlights: Women at High Risk for Diabetes--Access and Quality
of Care
• General Health and Well-being
– Overall, women at high risk for diabetes were more likely than women not at high risk for diabetes (NHRD) to report fair/poor health.
Highlights: Women at High Risk for Diabetes--Access and Quality
of Care
• Access to Care
– Regardless of diabetes risk status, women with a high school education or less were significantly more likely than women with more than a high school education to have been uninsured all year.
Highlights: Women at High Risk for Diabetes--Access and Quality
of Care • Diabetes-related Risk Reduction
– Women at high risk were significantly less likely than women NHRD to report exercising for at least 150 minutes/week.
– Women at high risk who had a high school education or less were significantly less likely than women NHRD who had more than h.s. education to have tried to lose weight in past year.
Highlights: AHRQ-CDC Reports
• Because many studies often have not stratified by sex, may be difficult to determine quality of care for women.
• These findings indicate disparities in access to and quality of care
– among women with and without diagnosed diabetes,
– as well as those at risk
Highlights: AHRQ-CDC Reports
• States could use this information from the 2 reports
– To develop programs to remove barriers to optimal care to reduce sex disparities in quality of health care delivered to women
– Programs could target women with or at risk for diabetes at specific life stages
– Focus on gaps in public health programs, policies, research, and surveillance
Action Steps • Analyze state data to determine gaps in access and
quality of care for women with at and high risk for diabetes
• Develop programs to reach women at high risk for diabetes, including gestational diabetes, with a focus on:
– Increasing education about prevention of type 2 diabetes
– Increasing access to preventive care services, especially dental care
– Increasing healthy lifestyles
– Increasing physical activity
Where are there still gaps?
• There is still more work that needs to be done
– To understand diabetes and women’s health issues across the lifestages
– To develop strategies to improve women’s health and well-being
Action Steps
• Educate community leaders about diabetes and its management and about the value of healthy environments.
– Develop diabetes education and communication programs in schools, workplaces, community health centers that focus on nutrition, physical activity, breastfeeding, and weight loss reduction.
– Advocate for the expansion of parks, sidewalks, playgrounds and other public recreational areas.
Action Steps
• Educate school personnel
– Build partnerships with boards of education, diabetes experts, school nurses, teachers, counselors, food service providers, parents, and students.
– Design and expand coordinated school health programs for diabetes.
– Develop campaigns for prevention of diabetes among female students at risk and for managing diabetes among those diagnosed with diabetes.
Action Steps
• Additional research is needed to better understand factors that influence diabetes and women’s health
– What is the societal cost of diabetes among women across all lifestages?
– What is the impact of depression on the lives of women across the lifestages with or at risk for diabetes?
– What is the extent of health care providers’ knowledge, beliefs, and practices related to risk factors, diagnoses, and preventive care for women across the lifestages?
– What do we know about diabetes prevention and intervention among women across all life stages?
• What is the implication of this knowledge for future programs and policies?
Summary
• The National Public Health Initiative on Diabetes and Women’s Health identified 10 priority areas for addressing the needs of women with or at risk for diabetes.
• There is a need to develop multiple partnerships across sectors to prevent and manage diabetes among women.
• Community interventions that reach women with and at risk for diabetes, and strategies to improve quality of care are needed.
The National Public Health Initiative on Diabetes and Women’s Health
• For more information about the Initiative on Diabetes and Women’s Health:
www.cdc.gov/diabetes/projects/women.htm
www.cdc.gov/diabetes/pubs/populations.htm
– Contact:
Michelle D. Owens-Gary, PhD
• 770-488-5014
