Diabetes in California Counties

Transcription

1 Diabetes in California Counties Issued April 2009 California Department of Public Health University of California, San Francisco

2 This publication was prepared in March 2009 by the using data from the 2005 California Health Interview Survey. The content included in this report may be reproduced with the following citation:. (2009). Diabetes in California Counties. Sacramento, CA: California Diabetes Program, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Authors Guozhong He, PhD, Karen Black, MSIS, Susan Lopez-Payan, Karin Omark, MPH, EdM, and Dean Schillinger, MD. Acknowledgments Design: Maran Kammer-Perez, Studio M Graphic Design Data analysis: Jerome Braun, PhD, University of California, Davis, Statistical Laboratory MS 7211, PO Box Sacramento, CA Ph: This publication was supported by Grant/Cooperative Agreement Number from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of CDC. This project was supported by the California Department of Public Health. The California Diabetes Program is the State s public health program for the prevention and control of diabetes, administered by the University of California, San Francisco, Institute for Health and Aging. Diabetes in California Counties

3 Table of contents Introduction by Dr. Dean Schillinger What is diabetes? Diabetes and its complications can be prevented. What factors are associated with type 2 diabetes? Recommendations for screening for type 2 diabetes Costs of diabetes Key objectives of the achievements About this document About the county diabetes reports About the county comparisons tables Methodolgy References i County Diabetes Reports Alameda County Alpine County Amador County Butte County Calaveras County Colusa County Contra Costa County Del Norte County El Dorado County Fresno County Glen County Humboldt County Imperial County Inyo County Kern County Kings County Lake County Lassen County Los Angeles County Madera County Marin County Mariposa County Mendocino County Merced County Modoc County Mono County Monterey County Napa County Nevada County Orange County Placer County Plumas County Riverside County Sacramento County San Benito County San Bernardino County San Diego County San Francisco County San Joaquin County San Luis Obispo County San Mateo County Santa Barbara County Santa Clara County Santa Cruz County Shasta County Sierra County Siskiyou County Solano County Sonoma County Stanislaus County Sutter County Tehama County Trinity County Tulare County Tuolumne County Ventura County Yolo County Yuba County State Diabetes Report California 64 California County Comparisons Annual A1C test Annual cholesterol test Diagnosed diabetes Annual eye exam Annual flu shot Annual foot exam Less than 5-a-day Heart disease High cholesterol High blood pressure Medi-Cal Medicare No usual source of care Obese Overweight Physical inactivity Current smoking Uninsured Diabetes in California Counties

4 Introduction by Dean Schillinger, MD As a primary care physician in a safety net hospital, I see patients every day who either have diabetes or are at high risk of developing diabetes. Our patients are the uninsured and the underinsured, the old and the young. Many are poor and their needs are great. I see how diabetes, for many people, can be a devastating disease that can alter their life s trajectory and present a challenge to family caregivers. Over the last 15 years, I have been working with a multidisciplinary team of clinical staff, researchers, and public health experts to develop ways to improve communication about diabetes and improve health outcomes. In 2008, I was able to join the wonderful team of the to try and bridge the gap between research and practice and to find ways to scale-up and disseminate successful interventions into population-based solutions. Diabetes is a complex disease that is sweeping the country. Its prevalence is strongly influenced by social circumstances and social policy and its management by health policy. California has nearly three million people with diabetes, meaning that more than 1 out of 10 adult Californians has diabetes. From 1998 to 2007, the prevalence of diagnosed diabetes rose from 5.5 to 7.6 percent, representing a 38 percent increase in one decade. California has the greatest number of people in the US who are newly diagnosed with diabetes. In 2007, about 7.9 million (29 percent, or nearly 1 in 3) adults in California had prediabetes, a condition that often precedes type 2 diabetes. Prevalence of gestational diabetes (diabetes that occurs in the context of pregnancy) has increased 60 percent in California in just seven years, from 3.3 percent of hospital deliveries in 1998 to 5.3 percent in In addition, small studies suggest a consistent increase in diabetes among children and youth. California s ethnically diverse population has a higher risk and prevalence of type 2 diabetes. Total health care and related costs for the treatment of diabetes in California alone is about $24.5 billion each year. As such, diabetes in California represents a significant and growing economic drain for families, employers, and communities, especially during these difficult economic times. Dr. Schillinger is a Professor of Medicine at University of California, San Francisco, Director of the UCSF Center for Vulnerable Populations, and Chief of the California Diabetes Program in the California Department of Public Health. His role as a practicing clinician at San Francisco General Hospital, a safety net hospital, has put him in a unique position to pursue influential and relevant research and advocacy related to improving care for vulnerable populations. This document presents some key diabetes statistics in California counties. Its purpose is to provide background information and facts about diabetes. In California, diabetes data are not captured in one statewide registry. Therefore, we have used data collected from the 2005 California Health Interview Survey (CHIS) and compiled a summary of information for each county. CHIS is the nation s largest state health survey. A randomdial telephone survey conducted every two years on a wide range of health topics, CHIS data give a detailed picture of the health and health care needs of California s large and diverse population. CHIS 2005 is currently the best data source in terms of county-level information, sub-population analyses, and diabetes indicators. More than 50,000 Diabetes in California Counties i

5 Californians are surveyed by CHIS. Participants in the CHIS survey are chosen at random and the sample is extensive enough to be statistically representative of California s diverse population. CHIS is especially known for its hard-to-find data on ethnic subgroups. The information herein can be used by county health departments, community-based organizations, and those providing clinical services to make strategic decisions about their current and future activities. Environmental planners, industry partners, the media, restaurants, schools, parks and recreation services, and many other groups also need to engage with these data to inform their work and modify their activities to help create the conditions in which people can make healthy choices. Compared to prior years, there are a number of new components to this report and some striking findings worthy of special comment. For this report, we have added annual cholesterol tests, annual eye exams, and annual flu shots received by people with diabetes under the Diabetes and Related Services section; current smoking in the section; and a new section,, which includes history of high blood pressure, high cholesterol, heart disease, type of insurance (Medicare, Medi- Cal, uninsured), and no usual source of care. All data are reported by county demographics in the general adults population and for adults with diabetes, when applicable. All data are reported in percentage rates. The county adult population total and adults with diagnosed diabetes total are provided at the top of each county table. Unlike the previous report, total numbers for each health condition/status are not provided in this report. Readers can easily calculate the total number by simply multiplying the rate with either the county adult population or the diagnosed diabetes population. Notable findings include: especially high rates of diabetes in California s Central Valley; high prevalence of being uninsured and having diabetes (especially among the Hispanic/Latino population), and the tremendous county-by-county variation in coverage of uninsured people with diabetes; and growing prevalence of diabetes in young adults (ages 18-44) and the behavioral and health access risk profiles that make them particularly vulnerable to developing complications in the prime of their lives. These include especially high rates of con-current tobacco use (20%) and heart disease (8%), high rates of un-insurance (30%), and low rates of receipt of recommended services such as eye exams and influenza vaccination. The serves as a coordinating leader for organizations working to prevent diabetes and its complications in California s diverse communities. We hope you will find these data useful and seek additional resources on our Diabetes Information Resource Center (DIRC) at. Diabetes in California Counties ii

6 What is diabetes? Diabetes is a chronic medical condition marked by high levels of blood glucose (a form of sugar) resulting from defects in insulin production, insulin action, or both. (1) There are several types of diabetes. Type 1 diabetes, previously known as juvenile diabetes, is an autoimmune disease in which the body does not produce the hormone insulin. There is no known way to prevent type 1 diabetes. Type 2 diabetes, previously known as adult-onset diabetes, is a metabolic disease in which the body does not make enough insulin or use it effectively. Type 2 diabetes can be prevented or delayed by maintaining a healthy weight and exercising regularly. Gestational diabetes occurs in pregnant women who have never had diabetes before but have higher than normal blood glucose levels during pregnancy. Without intervention, women with gestational diabetes have a percent chance of developing type 2 diabetes within 5-10 years. (1) Prediabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, and stroke. People with prediabetes have blood glucose levels higher than normal but not high enough to be classified as diabetes. Without intervention, about 25 percent of people with prediabetes will develop diabetes within 3-5 years. (2) Diabetes is the leading cause of blindness, amputations, and kidney failure, and is a major contributor to heart attacks and strokes. (1) Overall, the risk for death among people with diabetes is about twice that of people of similar age without diabetes. (1) Diabetes reduces life expectancy by eighteen years if diagnosed at age 20, fourteen years if diagnosed at age 40, and ten years if diagnosed at age 60. (3) Diabetes and its complications can be prevented. In 2002, a national clinical trial demonstrated that type 2 diabetes can be delayed or prevented by healthy lifestyle changes, including moderate weight loss and engagement in regular moderate-intensity physical activity. (4) The works with many partner organizations to promote awareness of diabetes risk factors, increase prediabetes screening, and support healthy communities that encourage healthy lifestyles. For people with diabetes, application of comprehensive, evidence-based diabetes detection, care, and multidisciplinary management strategies can also reduce the impact of diabetes and prevent or delay serious complications. Access to health care is critical for people with diabetes. Management of blood sugar levels, blood pressure, and blood lipids/cholesterol are particularly important. Regular services should also include eye, foot, kidney, and dental exams, as well as flu and pneumococcal vaccinations. Since diabetes must be managed on a daily basis by the person with the disease, self-management education is required and includes blood sugar monitoring, healthy diet, physical activity, weight management, and medication adherence, including aspirin therapy. Since tobacco use increases the risk of complications for people with diabetes, smoking cessation is strongly encouraged. Because the list of essential disease management recommendations is long and ever-changing, the promotes user-friendly clinical guidelines, multilingual tools, and educational programs to assist the clinician, the patient, and their family to succeed in managing the disease. Diabetes in California Counties

7 What factors are associated with type 2 diabetes? There are both genetic and environmental factors that contribute to the development of type 2 diabetes. These can include: Being overweight or obese Being physically inactive Having a family history of diabetes Being over 45 years old Having high blood pressure Having had a baby over 9 pounds or having a history of gestational diabetes Having prediabetes Coming from a minority ethnic group Having lower educational attainment Having a lower income Living in neighborhoods with a high concentration of fast food restaurants Recommendations for screening for type 2 diabetes (5) Routine testing for diabetes should be considered in all individuals at age 45 years and above; if normal, testing should be repeated at three-year intervals. Additionally, testing should be considered at any age or be carried out more frequently in individuals who are overweight and have additional risk factors. A diabetes risk assessment tool created by the will soon be available on DIRC (). This tool will provide internet users with a personalized risk assessment for prediabetes and diabetes. Costs of diabetes Direct medical costs for diabetes (e.g., hospitalizations, medical care, and treatment supplies) in California account for about $18.7 billion annually, with another $5.8 billion spent on indirect costs such as disability payments, time lost from work, and premature death. (6) Established in 1981, the is a partnership between the California Department of Public Health and the University of California, San Francisco, Institute for Health and Aging and is funded primarily by the Centers for Disease Control and Prevention (CDC). Guided by national and state goals as well as community input, the program is a coordinating leader for hundreds of multi-sector partners at the individual, community, health care, policy, and environmental levels. The mission of the is to prevent diabetes and its complications in California s diverse communities. The program is a national model and is grounded in the translation of scientific evidence into public health practice. Diabetes in California Counties

8 Key objectives of the are to: Conduct Surveillance to monitor statewide diabetes health status and risk factors. Provide Communications to increase awareness about diabetes. Guide Public Policy to support people with and at risk for diabetes. Offer leadership, guidance, and resources for Community Health Interventions. Improve the quality of care in Health Care Delivery Systems. Reduce diabetes-related Health Disparities. achievements Diabetes Primary Prevention Initiative (DPPI) The DPPI was funded by the Centers for Disease Control and Prevention (CDC) with the goal of exploring the translation of scientific evidence for diabetes prevention into feasible programs that could be conducted outside of the research setting in the face of limited resources. The has participated in all three focus areas of the DPPI project including the Intervention Focus Area to seek to translate those findings into an intervention using the Improvement and Chronic Care Models, the Surveillance Focus Area to develop a diabetes primary prevention surveillance system, and the System Dynamics Modeling Focus Area to test the utility of system dynamics modeling to support goal setting and decision-making. U.S./Mexico Border Diabetes Project To respond to a diabetes crisis in a high-risk population, the serves on the scientific and intervention advisory committees of the U.S./Mexico Border Diabetes Project, a binational project to determine the prevalence of diabetes along the border and to implement programs tailored to the needs of the region. Diabetes Information Resource Center (DIRC) To improve communications with organizations throughout the state, the created the online Diabetes Information Resource Center (DIRC), with more than 50,000 annual visits. DIRC features Profiles of partner organizations working to prevent or control diabetes; Resources such as patient education materials in multiple languages, surveillance reports, and intervention research studies; an Event Calendar; and a discussion Forum. DIRC serves as the foundation for the Program s communications and outreach activities and is a national model for public health information technology. Tobacco Cessation and Diabetes To encourage health care providers to assist their diabetes patients with smoking cessation, the California Diabetes Program partnered with diabetes educators to create a statewide cessation promotion campaign. The campaign trained diabetes educators to ask their patients if they smoke, advise them to quit, and refer them to the California Smokers Helpline. The campaign increased the percentage of diabetes educators who refer patients to the Helpline. North Central Valley To examine whether diabetes prevention could be accomplished outside of rigorous research studies, the partnered with Sutter Hospitals and the Sacramento Bee newspaper through funding from CDC s DPPI. Newspaper employees were screened for diabetes; if they were at high risk, they were enrolled in a Sutter wellness program. Participants lost weight and increased their physical activity. San Francisco Bay Area To support local communities efforts to efficiently combat diabetes, the developed a diabetes system dynamics model to illustrate factors affecting diabetes burden, including Diabetes in California Counties

9 obesity and prediabetes in the general population and the quality of diabetes medical care. Members of the Regional Diabetes Collaborative (RDC) of San Benito, Santa Cruz, and Monterey Counties were trained to use the model, which helped them identify service gaps and strengths and coordinate actions. South Central Valley To address the need for professional development and better communication among Central Valley public health practitioners, the served as the chair of the Central Valley Chronic Disease Partnership (CVCDP), which has hosted three health symposiums attended by a total of 853 participants representing 30 cities. Participants expressed appreciation for the opportunity to attend high-quality educational conferences in Central California and for addressing the challenges of delivering health care in an underserved area. Los Angeles Area To ensure that people with diabetes receive recommended care, the and Diabetes Coalition of California developed a Team Care Tool Kit, which guides health care providers in creating an interdisciplinary team to collaborate with patients to help manage their diabetes. The Team Care Tool Kit has been downloaded from DIRC more than 4,000 times. A health organization in San Bernardino County has used the tool kit, coupled with staff training, to implement team care in its system. San Diego Area To lead and guide community health interventions, the provided technical assistance to the San Diego Diabetes Coalition in conducting an evaluation of its partnership. Members were surveyed about the strengths and attributes of the Coalition, revealing strong support for its leadership and a desire to take more concrete actions to address diabetes. About this document This document was developed using data from the 2005 California Health Interview Survey (CHIS). It contains two sets of information about California and its counties: tables displaying the percent rate (%) of diabetes and related indicators, and tables showing rankings of the prevalence of diabetes and related indicators. As with any data, the findings presented here have their limitations. Data from CHIS are reported by respondents; this type of self-reported data may underestimate diabetes prevalence because many people do not know that they have diabetes. As many as 40% of the people with diabetes are undiagnosed, resulting in self-report rates as much as 68% lower than actual rates. (7) About the county diabetes reports The county diabetes reports compare the general population in California and within each county (adults with and without diabetes) to the adult population with diabetes, present information divided by county, age, gender, and race/ethnicity, and include the following indicators: Diabetes care for people with diabetes: rates of annual A1C testing, cholesterol testing, eye exams, foot exams, and flu shots. These indicators are part of recommended care for people with diabetes Diabetes risk factors in people with and without diabetes: smoking, overweight, obesity, inactivity, and less than 5 servings of fruits and vegetables a day. These indicators are risk factors for the development of type 2 diabetes and can affect diabetes control in those who are already diagnosed. Health status of people with and without diabetes: high blood pressure, high cholesterol, and heart Diabetes in California Counties

10 disease. These chronic diseases are common co-morbidities with diabetes and can increase the risk for developing type 2 diabetes. Access to care by people with and without diabetes: type of insurance (Medicare, Medi-Cal, no insurance) and no usual source of care. The type of insurance and access to health care can affect a person s ability to diagnose and treat his/her diabetes. This information offers counties an in-depth picture of the health of their populations. About the county comparison tables The county comparisons list counties and the state average from best to worst for each compared health indicator. A ranking of 1 represents the county has the best rate of the compared health indicator in California, and a ranking of 59 represents the county has worst rate, vice versa. For some indicators, having a high prevalence or rate is desirable and achieves a high ranking; for example, counties with higher rates of A1C tests are ranked higher (closer to number 1). In other cases, having a high prevalence or rate is undesirable and achieves a low ranking; for example, counties with higher rates of obesity are ranked lower (closer to number 59). This information allows counties to gauge their health status relative to other counties. When comparing rates across counties in the county comparison tables, readers should also consider the ageadjusted rates, which offer some degree of standardized comparison, and confidence intervals, which show if there is any statistical significance to the differences between counties. For more information about the specific methodology used in generating this information, please see the Methodology section at the end of the report. Diabetes in California Counties

11 Alameda County Diabetes Report Alameda has a total of 1,136,948 adults; among those 73,902 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Population * Diagnosed diabetes * Annual A1C test * Annual cholesterol test * Annual eye exam * Annual foot exam * Annual flu shot * Current smoking * Overweight * Obese * Physical inactivity * Less than 5-a-day * High blood pressure * High cholesterol * Heart disease * Medicare * Medi-cal * Uninsured * No usual source of care * Diabetes in California Counties

12 Alpine County Diabetes Report Alpine has a total of 1,064 adults; among those 63 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Diabetes in California Counties Population Diagnosed diabetes Annual A1C test 94.8 * * * 87.6 Annual cholesterol test * * * Annual eye exam 83.7 * * * 80.3 Annual foot exam 64.7 * * * 72.3 Annual flu shot 61.9 * * * 44.6 Current smoking * * * * * Overweight * * * * * Obese * * * * * Physical inactivity * * * * * Less than 5-a-day * * * * * High blood pressure * * * * * High cholesterol * * * * * Heart disease * * * * * Medicare * * * * * Medi-cal * * * * * Uninsured * * * * * No usual source of care * * * * * Smaller population counties were aggregated into county groups and shared the same average rates within the county group. See details in the Methodology section.

13 Amador County Diabetes Report Amador has a total of 31,337 adults; among those 1,849 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Diabetes in California Counties Population Diagnosed diabetes Annual A1C test 94.8 * * * 87.6 Annual cholesterol test * * * Annual eye exam 83.7 * * * 80.3 Annual foot exam 64.7 * * * 72.3 Annual flu shot 61.9 * * * 44.6 Current smoking * * * * * Overweight * * * * * Obese * * * * * Physical inactivity * * * * * Less than 5-a-day * * * * * High blood pressure * * * * * High cholesterol * * * * * Heart disease * * * * * Medicare * * * * * Medi-cal * * * * * Uninsured * * * * * No usual source of care * * * * * Smaller population counties were aggregated into county groups and shared the same average rates within the county group. See details in the Methodology section.

14 Butte County Diabetes Report Butte has a total of 166,967 adults; among those 16,196 have diabetes. Population Diagnosed diabetes Annual A1C test * * Annual cholesterol test * * Annual eye exam * * Annual foot exam * * Annual flu shot * * Current smoking * 29.9 * Overweight * 38.3 * Obese * 21.4 * Physical inactivity * 11.4 * Less than 5-a-day * 57.8 *. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. High blood pressure * 22.1 * High cholesterol * 37.6 * Heart disease * 18.3 * Medicare * 25.6 * Medi-cal * 7.9 * Uninsured * 24.4 * No usual source of care * 2.6 * Diabetes in California Counties

15 Calaveras County Diabetes Report Calaveras has a total of 36,540 adults; among those 2,156 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Population Diagnosed diabetes Annual A1C test 94.8 * * * 87.6 Annual cholesterol test * * * Annual eye exam 83.7 * * * 80.3 Annual foot exam 64.7 * * * 72.3 Annual flu shot 61.9 * * * 44.6 Current smoking * * * * * Overweight * * * * * Obese * * * * * Physical inactivity * * * * * Less than 5-a-day * * * * * High blood pressure * * * * * High cholesterol * * * * * Heart disease * * * * * Medicare * * * * * Medi-cal * * * * * Uninsured * * * * * No usual source of care * * * * * Smaller population counties were aggregated into county groups and shared the same average rates within the county group. See details in the Methodology section. 10 Diabetes in California Counties 10

16 Colusa County Diabetes Report Colusa has a total of 15,210 adults; among those 1,430 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Population Diagnosed diabetes Annual A1C test * * Annual cholesterol test * * 91.8 Annual eye exam * * 51.3 Annual foot exam * * 73.8 Annual flu shot * * 59.8 Current smoking * 14.9 * Overweight * 45.0 * Obese * 45.8 * Physical inactivity * 24.1 * Less than 5-a-day * 33.3 * High blood pressure * 45.0 * High cholesterol * 35.8 * Heart disease * 0.0 * Medicare * 0.0 * Medi-cal * 66.7 * Uninsured * 66.7 * No usual source of care * 9.2 * Smaller population counties were aggregated into county groups and shared the same average rates within the county group. See details in the Methodology section. Diabetes in California Counties 11

17 Contra Costa County Diabetes Report Contra Costa has a total of 766,272 adults; among those 40,612 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Population Diagnosed diabetes Annual A1C test * Annual cholesterol test * Annual eye exam * Annual foot exam * Annual flu shot * Current smoking * Overweight * Obese * Physical inactivity * Less than 5-a-day * High blood pressure * High cholesterol * Heart disease * Medicare * Medi-cal * Uninsured * No usual source of care * Diabetes in California Counties 12

18 Del Norte County Diabetes Report Del Norte has a total of 23,018 adults; among those 1,289 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Population Diagnosed diabetes * Annual A1C test 78.3 * * * * * Annual cholesterol test 93.7 * * * * * Annual eye exam 67.7 * * * * * Annual foot exam 37.3 * * * * * Annual flu shot 44.3 * * * * * Current smoking * * * * 0.0 * 37.1 * Overweight * * * * 0.0 * 18.1 * Obese * * * * 43.6 * 54.7 * Physical inactivity * * * * 37.9 * 14.6 * Less than 5-a-day * * * * 0.0 * 43.6 * High blood pressure * * * * 43.6 * 49.2 * High cholesterol * * * * 43.6 * 33.9 * Heart disease * * * * 0.0 * 11.6 * Medicare * * * * 37.9 * 15.4 * Medi-cal * * * * 0.0 * 18.1 * Uninsured * * * * 0.0 * 28.3 * No usual source of care * * * * 0.0 * 0.0 * Smaller population counties were aggregated into county groups and shared the same average rates within the county group. See details in the Methodology section. Diabetes in California Counties 13

19 El Dorado County Diabetes Report El Dorado has a total of 134,180 adults; among those 7,514 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Population Diagnosed diabetes Annual A1C test 90.3 * * * * * Annual cholesterol test 87.2 * * * * * Annual eye exam 65.8 * * * * * Annual foot exam 66.8 * * * * * Annual flu shot 57.1 * * * * * Current smoking * * 30.0 * 0.0 * 25.3 * Overweight * * 39.0 * 32.6 * 54.5 * Obese * * 43.8 * 0.0 * 18.6 * Physical inactivity * * 0.0 * 0.0 * 9.8 * Less than 5-a-day * * 43.8 * 47.1 * 32.8 * High blood pressure * * 31.5 * 20.3 * 18.6 * High cholesterol * * 52.8 * 11.7 * 44.2 * Heart disease * * 0.0 * 0.0 * 2.4 * Medicare * * 32.9 * 20.3 * 12.3 * Medi-cal * * 43.8 * 35.4 * 0.0 * Uninsured * * 0.0 * 0.0 * 16.8 * No usual source of care * * 0.0 * 0.0 * 9.1 * Diabetes in California Counties 14

20 Fresno County Diabetes Report Fresno has a total of 622,750 adults; among those 48,575 have diabetes. Population Diagnosed diabetes Annual A1C test * Annual cholesterol test * Annual eye exam * Annual foot exam * Annual flu shot * Current smoking * Overweight * Obese * Physical inactivity * Less than 5-a-day * (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. High blood pressure * High cholesterol * Heart disease * Medicare * Medi-cal * Uninsured * No usual source of care * Diabetes in California Counties 15

21 Glen County Diabetes Report Glen has a total of 20,548 adults; among those 1,932 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Population Diagnosed diabetes Annual A1C test * * Annual cholesterol test * * 91.8 Annual eye exam * * 51.3 Annual foot exam * * 73.8 Annual flu shot * * 59.8 Current smoking * 14.9 * Overweight * 45.0 * Obese * 45.8 * Physical inactivity * 24.1 * Less than 5-a-day * 33.3 * High blood pressure * 45.0 * High cholesterol * 35.8 * Heart disease * 0.0 * Medicare * 0.0 * Medi-cal * 66.7 * Uninsured * 66.7 * No usual source of care * 9.2 * Smaller population counties were aggregated into county groups and shared the same average rates within the county group. See details in the Methodology section. 16 Diabetes in California Counties 16

22 Humboldt County Diabetes Report Humboldt has a total of 102,838 adults; among those 6,273 have diabetes. Population Diagnosed diabetes * Annual A1C test * * 95.2 Annual cholesterol test * * 95.2 Annual eye exam * * Annual foot exam * * 77.1 Annual flu shot * * 84.8 Current smoking * * 0.0 * Overweight * * 45.8 * Obese * * 0.0 * Physical inactivity * * 0.0 * Less than 5-a-day * * 20.3 * (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. High blood pressure * * 2.7 * High cholesterol * * 30.0 * Heart disease * * 0.0 * Medicare * * 0.0 * Medi-cal * * 43.2 * Uninsured * * 27.0 * No usual source of care * * 24.2 * Diabetes in California Counties 17

23 Imperial County Diabetes Report Imperial has a total of 118,067 adults; among those 12,869 have diabetes.. (2009). Diabetes in California Counties. Sacramento, CA:, California Department of Public Health; University of California San Francisco, Institute for Health and Aging. Population Diagnosed diabetes Annual A1C test * * * Annual cholesterol test * * * Annual eye exam * * * Annual foot exam * * * Annual flu shot * * * Current smoking * 30.8 * 40.7 * Overweight * 42.7 * 18.4 * Obese * 0.0 * 58.7 * Physical inactivity * 0.0 * 11.8 * Less than 5-a-day * * 88.5 * High blood pressure * 0.0 * 29.1 * High cholesterol * 0.0 * 30.2 * Heart disease * 0.0 * 8.3 * Medicare * 30.8 * 21.5 * Medi-cal * 0.0 * 20.1 * Uninsured * 45.2 * 41.6 * No usual source of care * 12.0 * 7.6 * Diabetes in California Counties 18