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

24 Inyo County Diabetes Report Inyo has a total of 14,722 adults; among those 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 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. Diabetes in California Counties 19

25 Kern County Diabetes Report Kern has a total of 533,407 adults; among those 55,474 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 * 96.1 Annual cholesterol test * 96.1 Annual eye exam * 28.1 Annual foot exam * 79.6 Annual flu shot * 54.4 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 20

26 Kings County Diabetes Report Kings has a total of 104,856 adults; among those 10,800 have diabetes. Population Diagnosed diabetes Annual A1C test * 34.8 Annual cholesterol test * 21.5 Annual eye exam * 17.1 Annual foot exam * 74.5 Annual flu shot * 34.8 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 21

27 Lake County Diabetes Report Lake has a total of 50,309 adults; among those 3,421 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 * 44.2 * 0.0 * 39.1 * Overweight * 38.1 * 0.0 * 26.0 * Obese * 17.7 * 0.0 * 38.4 * Physical inactivity * 44.2 * 0.0 * 19.1 * Less than 5-a-day * 63.8 * 68.2 * 48.2 * High blood pressure * 55.8 * 31.8 * 43.2 * High cholesterol * 18.5 * 0.0 * 11.4 * Heart disease * 19.6 * 31.8 * 14.6 * Medicare * 55.8 * 31.8 * 20.3 * Medi-cal * 0.0 * 31.8 * 37.7 * Uninsured * 0.0 * 0.0 * 37.6 * No usual source of care * 0.0 * 0.0 * 20.7 * Diabetes in California Counties 22

28 Lassen County Diabetes Report Lassen has a total of 28,759 adults; among those 1,611 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 23

29 Los Angeles County Diabetes Report Los Angeles has a total of 7,346,813 adults; among those 528,971 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 24

30 Madera County Diabetes Report Madera has a total of 101,992 adults; among those 8,669 have diabetes. Population Diagnosed diabetes Annual A1C test * Annual cholesterol test * Annual eye exam * Annual foot exam * Annual flu shot * 61.0 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 25

31 Marin County Diabetes Report Marin has a total of 199,187 adults; among those 7,569 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 26

32 Mariposa County Diabetes Report Mariposa has a total of 14,995 adults; among those 885 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. Diabetes in California Counties 27

33 Mendocino County Diabetes Report Mendocino has a total of 69,279 adults; among those 2,979 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 * * 9.7 * 44.3 * Overweight * * 50.2 * 21.2 * Obese * * 0.0 * 36.6 * Physical inactivity * * 0.0 * 11.2 * Less than 5-a-day * * 9.7 * 40.3 * High blood pressure * * 11.9 * 21.9 * High cholesterol * * 0.0 * 37.9 * Heart disease * * 0.0 * 5.3 * Medicare * * 20.4 * 16.1 * Medi-cal * * 0.0 * 45.7 * Uninsured * * 11.9 * 44.3 * No usual source of care * * 0.0 * 4.8 * Diabetes in California Counties 28

34 Merced County Diabetes Report Merced has a total of 166,400 adults; among those 14,477 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 29

35 Modoc County Diabetes Report Modoc has a total of 8,040 adults; among those 450 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. 30 Diabetes in California Counties 30

36 Mono County Diabetes Report Mono has a total of 10,862 adults; among those 641 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. Diabetes in California Counties 31

37 Monterey County Diabetes Report Monterey has a total of 301,332 adults; among those 24,408 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 * 80.8 * Annual cholesterol test * * Annual eye exam * * Annual foot exam * 70.4 * 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 32

38 Napa County Diabetes Report Napa has a total of 100,857 adults; among those 8,371 have diabetes. Population Diagnosed diabetes Annual A1C test * * 79.6 Annual cholesterol test * * 79.6 Annual eye exam * * 36.7 Annual foot exam * * 71.6 Annual flu shot * * 8.0 Current smoking * * 28.8 * Overweight * * 30.2 * Obese * * 14.3 * Physical inactivity * * 14.3 * Less than 5-a-day * * 50.0 * (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 * * 0.0 * High cholesterol * * 0.0 * Heart disease * * 0.0 * Medicare * * 0.0 * Medi-cal * * 0.0 * Uninsured * * 14.3 * No usual source of care * * 35.4 * Diabetes in California Counties 33

39 Nevada County Diabetes Report Nevada has a total of 79,002 adults; among those 2,765 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 88.2 * * * * * Annual cholesterol test * * * * * Annual eye exam 80.5 * * * * * Annual foot exam 74.2 * * * * * Annual flu shot 49.4 * * * * * Current smoking * * * * 6.8 * 42.7 * Overweight * * * * 49.5 * 24.3 * Obese * * * * 23.2 * 40.3 * Physical inactivity * * * * 0.0 * 0.0 * Less than 5-a-day * * * * 56.4 * 59.2 * High blood pressure * * * * 43.8 * 0.0 * High cholesterol * * * * 23.4 * 13.9 * Heart disease * * * * 20.4 * 0.0 * Medicare * * * * 0.0 * 3.2 * Medi-cal * * * * 26.1 * 36.1 * Uninsured * * * * 0.0 * 16.9 * No usual source of care * * * * 30.1 * 13.5 * Diabetes in California Counties 34

40 Orange County Diabetes Report Orange has a total of 2,261,541 adults; among those 131,169 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 35

41 Placer County Diabetes Report Placer has a total of 231,229 adults; among those 11,330 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 91.2 * * * * Annual cholesterol test 85.9 * * * * Annual eye exam 92.3 * * * * Annual foot exam 79.4 * * * * Annual flu shot 71.4 * * * * Current smoking * * 10.8 * 27.6 * Overweight * * 24.5 * 38.9 * Obese * * 5.4 * 27.4 * Physical inactivity * * 0.0 * 5.4 * Less than 5-a-day * * 49.6 * 51.8 * High blood pressure * * 51.0 * 7.5 * High cholesterol * * 19.3 * 3.3 * Heart disease * * 0.0 * 1.9 * Medicare * * 20.0 * 7.8 * Medi-cal * * 3.7 * 1.9 * Uninsured * * 0.0 * 35.3 * No usual source of care * * 15.6 * 25.2 * Diabetes in California Counties 36

42 Plumas County Diabetes Report Plumas has a total of 17,404 adults; among those 975 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 37

43 Riverside County Diabetes Report Riverside has a total of 1,360,202 adults; among those 115,617 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 38

44 Sacramento County Diabetes Report Sacramento has a total of 999,033 adults; among those 57,944 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 39

45 San Benito County Diabetes Report San Benito has a total of 40,144 adults; among those 3,533 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 * * 17.9 Current smoking * * 29.6 * Overweight * * 22.9 * Obese * * 13.3 * Physical inactivity * * 3.5 * Less than 5-a-day * * 27.1 * High blood pressure * * 46.5 * High cholesterol * * 5.4 * Heart disease * * 0.0 * Medicare * * 3.2 * Medi-cal * * 0.0 * Uninsured * * 3.5 * No usual source of care * * 50.2 * Diabetes in California Counties 40

46 San Bernardino County Diabetes Report San Bernardino has a total of 1,373,824 adults; among those 98,915 have diabetes. Population Diagnosed diabetes Annual A1C test * 87.4 Annual cholesterol test * 63.9 Annual eye exam * 71.8 Annual foot exam * 64.9 Annual flu shot * 29.0 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 41

47 San Diego County Diabetes Report San Diego has a total of 2,251,798 adults; among those 130,604 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 42

48 San Francisco County Diabetes Report San Francisco has a total of 681,701 adults; among those 42,265 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 43

49 San Joaquin County Diabetes Report San Joaquin has a total of 446,550 adults; among those 41,083 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 * 77.1 Annual cholesterol test * 93.1 Annual eye exam * 93.1 Annual foot exam * 93.1 Annual flu shot * 8.1 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 44

50 San Luis Obispo County Diabetes Report San Luis Obispo has a total of 207,144 adults; among those 9,736 have diabetes. Population Diagnosed diabetes Annual A1C test * * * * Annual cholesterol test * * * * Annual eye exam * * * * Annual foot exam * * * * Annual flu shot * * * * Current smoking * 0.0 * 20.0 * 38.8 * Overweight * 73.0 * 8.2 * 52.9 * Obese * 0.0 * 11.1 * 13.1 * Physical inactivity * 27.0 * 0.0 * 4.2 * Less than 5-a-day * 79.7 * 90.0 * 23.6 *. (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 * 12.1 * 11.1 * 31.2 * High cholesterol * 11.6 * 55.8 * 0.0 * Heart disease * 0.0 * 0.0 * 0.0 * Medicare * 8.2 * 22.1 * 7.2 * Medi-cal * 0.0 * 22.1 * 15.3 * Uninsured * 0.0 * 23.6 * 12.2 * No usual source of care * 49.3 * 1.5 * 1.4 * Diabetes in California Counties 45

51 San Mateo County Diabetes Report San Mateo has a total of 558,531 adults; among those 32,953 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 46

52 Santa Barbara County Diabetes Report Santa Barbara has a total of 313,614 adults; among those 26,344 have diabetes. Population Diagnosed diabetes Annual A1C test * * * Annual cholesterol test * * * Annual eye exam * * * Annual foot exam * * * Annual flu shot * * * Current smoking * 0.0 * 55.2 * Overweight * 28.4 * 25.7 * Obese * 35.5 * 7.2 * Physical inactivity * 9.5 * 0.7 * Less than 5-a-day * 56.0 * 69.2 *. (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 * 29.7 * 12.6 * High cholesterol * 7.1 * 6.1 * Heart disease * 9.5 * 3.9 * Medicare * 13.5 * 9.5 * Medi-cal * 9.5 * 27.4 * Uninsured * 35.5 * 17.1 * No usual source of care * 35.5 * 48.5 * Diabetes in California Counties 47

53 Santa Clara County Diabetes Report Santa Clara has a total of 1,310,825 adults; among those 102,244 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 48

54 Santa Cruz County Diabetes Report Santa Cruz has a total of 203,060 adults; among those 7,107 have diabetes. Population Diagnosed diabetes Annual A1C test 83.0 * * * * Annual cholesterol test 83.0 * * * * Annual eye exam 77.8 * * * * Annual foot exam 70.7 * * * * Annual flu shot 61.3 * * * * Current smoking * * 0.0 * 32.5 * Overweight * * 36.6 * 56.5 * Obese * * 18.7 * 11.4 * Physical inactivity * * 7.0 * 0.0 * Less than 5-a-day * * 47.8 * 42.1 *. (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 * * 14.6 * 21.8 * High cholesterol * * 12.8 * 26.0 * Heart disease * * 4.5 * 2.4 * Medicare * * 12.1 * 11.4 * Medi-cal * * 7.6 * 13.0 * Uninsured * * 14.7 * 0.0 * No usual source of care * * 14.4 * 5.1 * Diabetes in California Counties 49

55 Shasta County Diabetes Report Shasta has a total of 136,425 adults; among those 8,322 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 87.1 * * * 92.3 Annual cholesterol test 94.1 * * * 92.3 Annual eye exam 87.8 * * * 32.3 Annual foot exam 58.8 * * * 46.4 Annual flu shot 59.3 * * * 45.9 Current smoking * * * 0.0 * Overweight * * * 68.2 * Obese * * * 0.0 * Physical inactivity * * * 0.0 * Less than 5-a-day * * * 0.0 * High blood pressure * * * 0.0 * High cholesterol * * * 0.0 * Heart disease * * * 0.0 * Medicare * * * 12.0 * Medi-cal * * * 0.0 * Uninsured * * * 68.2 * No usual source of care * * * 7.2 * Diabetes in California Counties 50

56 Sierra County Diabetes Report Sierra has a total of 3,027 adults; among those 170 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 51

57 Siskiyou County Diabetes Report Siskiyou has a total of 36,225 adults; among those 2,029 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. 52 Diabetes in California Counties 52

58 Solano County Diabetes Report Solano has a total of 308,784 adults; among those 26,247 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 53

59 Sonoma County Diabetes Report Sonoma has a total of 362,525 adults; among those 17,764 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 92.5 * * * * Annual cholesterol test 82.1 * * * * Annual eye exam 75.8 * * * * Annual foot exam 85.8 * * * * Annual flu shot 64.5 * * * * Current smoking * * 0.0 * 41.2 * Overweight * * 28.0 * 53.0 * Obese * * 0.0 * 23.7 * Physical inactivity * * 9.6 * 11.6 * Less than 5-a-day * * 43.1 * 51.9 * High blood pressure * * 28.4 * 24.9 * High cholesterol * * 33.4 * 19.9 * Heart disease * * 9.6 * 7.8 * Medicare * * 19.7 * 18.9 * Medi-cal * * 0.0 * 15.8 * Uninsured * * 9.6 * 4.1 * No usual source of care * * 0.0 * 0.0 * Diabetes in California Counties 54

60 Stanislaus County Diabetes Report Stanislaus has a total of 346,999 adults; among those 32,618 have diabetes. Population Diagnosed diabetes Annual A1C test * * 88.9 Annual cholesterol test * * 88.9 Annual eye exam * * 86.4 Annual foot exam * * 76.3 Annual flu shot * * 88.9 Current smoking * 4.1 * Overweight * 56.2 * Obese * 0.0 * Physical inactivity * 6.5 * Less than 5-a-day * 54.6 * (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 * 12.7 * High cholesterol * 5.7 * Heart disease * 0.0 * Medicare * 23.4 * Medi-cal * 20.8 * Uninsured * 30.3 * No usual source of care * 4.8 * Diabetes in California Counties 55

61 Sutter County Diabetes Report Sutter has a total of 63,749 adults; among those 6,184 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 * 0.0 * 30.4 * Overweight * 41.4 * 64.2 * Obese * 3.6 * 18.1 * Physical inactivity * 5.1 * 21.0 * Less than 5-a-day * 62.2 * 47.6 * High blood pressure * 31.2 * 22.8 * High cholesterol * 12.2 * 36.0 * Heart disease * 10.5 * 0.3 * Medicare * 8.9 * 4.0 * Medi-cal * 7.8 * 17.6 * Uninsured * 3.6 * 38.5 * No usual source of care * 0.0 * 7.3 * Diabetes in California Counties 56

62 Tehama County Diabetes Report Tehama has a total of 45,902 adults; among those 4,315 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 57

63 Trinity County Diabetes Report Trinity has a total of 11,455 adults; among those 641 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. 58 Diabetes in California Counties 58

64 Tulare County Diabetes Report Tulare has a total of 284,193 adults; among those 26,714 have diabetes. Population Diagnosed diabetes Annual A1C test * * Annual cholesterol test * * Annual eye exam * * Annual foot exam * * 70.0 Annual flu shot * * 32.6 Current smoking * 22.6 * Overweight * 8.5 * Obese * 0.0 * Physical inactivity * 0.0 * Less than 5-a-day * 25.9 * (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 * 32.7 * High cholesterol * 0.0 * Heart disease * 0.0 * Medicare * 23.1 * Medi-cal * 10.2 * Uninsured * 0.0 * No usual source of care * 0.0 * Diabetes in California Counties 59

65 Tuolumne County Diabetes Report Tuolumne has a total of 47,161 adults; among those 2,782 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. 60 Diabetes in California Counties 60

66 Ventura County Diabetes Report Ventura has a total of 597,101 adults; among those 39,409 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 61

67 Yolo County Diabetes Report Yolo has a total of 142,784 adults; among those 8,995 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 * 6.8 * 4.6 * Overweight * 17.6 * 28.2 * Obese * 1.0 * 25.0 * Physical inactivity * 15.7 * 14.7 * Less than 5-a-day * 54.3 * 40.4 * High blood pressure * 16.6 * 25.1 * High cholesterol * 6.9 * 35.5 * Heart disease * 3.1 * 0.0 * Medicare * 8.6 * 24.7 * Medi-cal * 3.9 * 9.0 * Uninsured * 12.1 * 0.0 * No usual source of care * 2.2 * 14.8 * Diabetes in California Counties 62

68 Yuba County Diabetes Report Yuba has a total of 48,673 adults; among those 4,721 have diabetes. Population Diagnosed diabetes Annual A1C test * * * Annual cholesterol test * * * Annual eye exam * * * Annual foot exam * * * Annual flu shot * * * Current smoking * 0.0 * 28.0 * Overweight * 43.1 * 35.8 * Obese * 12.9 * 25.7 * Physical inactivity * 0.0 * 31.7 * Less than 5-a-day * 84.9 * 36.3 *. (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 * 7.5 * 35.2 * High cholesterol * 2.3 * 23.2 * Heart disease * 7.5 * 5.5 * Medicare * 7.5 * 27.1 * Medi-cal * 15.1 * 12.1 * Uninsured * 24.6 * 31.9 * No usual source of care * 52.4 * 7.3 * Diabetes in California Counties 63

69 California Diabetes Report California has a total of 26,998,154 adults; among those 1,889,871 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 64

70 California County Comparisons Annual A1C test Rank Rate Lower Age Rate Lower Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne San Francisco Sonoma San Benito Placer Santa Clara San Luis Obispo El Dorado Yuba San Mateo Nevada Solano Ventura Marin Shasta San Joaquin Kern Sutter Mendocino Merced Alameda Colusa Glen Tehama Napa Yolo Butte Los Angeles Sacramento California Santa Cruz Monterey Santa Barbara Rank Rate Lower Age Rate Lower San Diego Fresno Riverside Lake San Bernardino Madera Stanislaus Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Imperial Humboldt Contra Costa Orange Kings Tulare Annual A1C test is the percent of adults with diabetes who had at least one A1C test during the last 12 months. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in persons with diabetes. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 65

71 California County Comparisons Annual cholesterol test Rank Rate Lower Age Rate Lower Alpine Amador Calaveras Inyo Mariposa Mono Nevada Tuolumne San Benito Riverside San Mateo Butte Marin Sacramento Ventura Shasta Yuba Solano Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Fresno Contra Costa Humboldt San Luis Obispo San Joaquin San Diego Imperial Colusa Glen Tehama Los Angeles California Kern Sutter Rank Rate Lower Age Rate Lower Napa Merced San Bernardino El Dorado Orange Monterey Mendocino Placer Santa Barbara Santa Clara Madera Yolo Kings Santa Cruz Alameda Sonoma Tulare Stanislaus San Francisco Lake Annual cholesterol test is the percent of adults with diabetes who had at least one cholesterol test during the last 12 months. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in the general population. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 66

72 California County Comparisons Diagnosed diabetes Rank Rate Lower Age Rate Lower Santa Cruz Nevada Marin Mendocino San Luis Obispo Placer Sonoma Contra Costa Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity El Dorado Sacramento San Diego Orange Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne San Mateo Humboldt Shasta San Francisco Yolo Alameda Ventura Lake California Los Angeles San Bernardino Santa Clara Fresno Rank Rate Lower Age Rate Lower Monterey Napa Santa Barbara Solano Riverside Madera Merced San Benito San Joaquin Colusa Glen Tehama Stanislaus Tulare Butte Sutter Yuba Kings Kern Imperial Diagnosed diabetes is the percent of adults with diagnosed diabetes, including both type 1 and type 2 diabetes. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in the general population. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 67

73 California County Comparisons Annual eye exam Rank Rate Lower Age Rate Lower Placer Shasta Contra Costa Yolo Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne San Benito San Joaquin Nevada Riverside Santa Cruz San Francisco Solano San Luis Obispo Sonoma Orange Imperial Alameda Santa Barbara Merced Sacramento Humboldt Lake Tulare Marin San Diego California Los Angeles Mendocino Colusa Glen Tehama Del Norte Lassen Rank Rate Lower Age Rate Lower Modoc Plumas Sierra Siskiyou Trinity Santa Clara Sutter El Dorado Butte Kings Fresno Ventura San Mateo San Bernardino Yuba Napa Stanislaus Madera Kern Monterey Annual eye exam is the percent of adults with diabetes who had at least one dilated eye exam during the last 12 months. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in persons with diabetes. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 68

74 California County Comparisons Annual flu shot Rank Rate Lower Age Rate Lower Contra Costa Placer San Francisco Fresno Sonoma San Mateo Yolo Sutter Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Santa Cruz San Luis Obispo Santa Clara Solano Shasta Monterey Marin Lake Sacramento El Dorado Riverside Kings San Diego Tulare California Ventura Alameda Nevada Colusa Glen Tehama Yuba Orange Imperial Rank Rate Lower Age Rate Lower Humboldt San Bernardino Los Angeles San Joaquin Merced San Benito Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Santa Barbara Kern Butte Madera Napa Mendocino Stanislaus Annual flu shot is the percent of adults with diabetes who had a flu shot during the last 12 months. Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in persons with diabetes. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 69

75 California County Comparisons Annual foot exam Rank Rate Lower Age Rate Lower Sonoma Placer San Benito Fresno Nevada Yuba San Mateo Ventura Santa Cruz San Joaquin El Dorado San Luis Obispo Alameda Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne San Bernardino Monterey Riverside Yolo Solano Imperial San Diego California Stanislaus Butte Sutter Merced Colusa Glen Tehama Orange Contra Costa San Francisco Madera Rank Rate Lower Age Rate Lower Los Angeles Marin Santa Clara Shasta Kern Sacramento Kings Lake Mendocino Napa Santa Barbara Tulare Humboldt Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Annual foot exam is the percent of adults with diabetes who had at least one foot exam by a health professional during the last 12 months. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in persons with diabetes. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 70

76 California County Comparisons Less than 5-a-day Rank Rate Lower Age Rate Lower El Dorado Santa Cruz Sonoma Nevada Kings Placer San Mateo Ventura San Benito Santa Barbara Merced Yuba Mendocino San Bernardino Santa Clara Colusa Glen Tehama Contra Costa Butte Humboldt Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Riverside San Joaquin Los Angeles Monterey Lake Yolo Sacramento California San Francisco Tulare Stanislaus Rank Rate Lower Age Rate Lower Kern Imperial Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Fresno Marin San Diego Shasta Napa Alameda San Luis Obispo Orange Madera Solano Sutter Less than 5-a-day is the percent of adults with diabetes who on average consume less than 5 servings of fruits and vegetables a day during the past month. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in the general population. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 71

77 California County Comparisons Heart disease Rank Rate Lower Age Rate Lower Kings Santa Barbara Imperial San Bernardino Napa San Francisco Monterey Humboldt Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Merced Placer San Benito Sacramento Los Angeles Alameda San Joaquin San Mateo Santa Cruz Orange Colusa Glen Tehama Santa Clara Yuba Yolo California San Diego Madera Marin Sutter Butte Riverside Fresno Rank Rate Lower Age Rate Lower Solano Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity San Luis Obispo Tulare Mendocino Contra Costa Sonoma Stanislaus Nevada El Dorado Lake Kern Shasta Ventura Heart disease is the percent of adults with diabetes who had any kind of heart disease. Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in the general population. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 72

78 California County Comparisons High cholesterol Rank Rate Lower Age Rate Lower San Benito Imperial Nevada Mendocino San Luis Obispo Fresno Butte Shasta San Francisco Contra Costa Madera Stanislaus Sutter San Bernardino Santa Clara Santa Cruz Alameda Marin Merced Sacramento Ventura Yolo Kings California Santa Barbara Tulare Solano San Diego Humboldt Monterey El Dorado Riverside Orange San Joaquin Los Angeles Kern Sonoma Lake Colusa Rank Rate Lower Age Rate Lower Glen Tehama Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Placer Napa Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Yuba San Mateo High cholesterol is the percent of adults with diabetes who had been told by a doctor that they had high cholesterol. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in the general population. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 73

79 California County Comparisons High blood pressure Rank Rate Lower Age Rate Lower Mendocino Santa Cruz Colusa Glen Tehama Monterey Santa Clara Kings Imperial San Bernardino Butte Orange Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Marin Santa Barbara Stanislaus Sacramento Los Angeles Alameda Sonoma Yuba Humboldt El Dorado California Yolo San Diego San Benito San Francisco San Joaquin Riverside Nevada San Luis Obispo Del Norte Rank Rate Lower Age Rate Lower Lassen Modoc Plumas Sierra Siskiyou Trinity Contra Costa Tulare Fresno Kern Napa Merced Solano Shasta Lake San Mateo Sutter Placer Madera Ventura High blood pressure is the percent of adults with diabetes who had been told by a doctor that they had high blood pressure. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in the general population. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 74

80 California County Comparisons Medi-Cal Rank Rate Lower Age Rate Lower San Mateo Napa El Dorado Marin Lake Riverside Solano Orange Santa Barbara Santa Clara Ventura Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity San Luis Obispo San Diego Monterey Kings San Joaquin Sonoma Sacramento San Benito Madera Alameda Santa Cruz California Los Angeles Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Placer Rank Rate Lower Age Rate Lower San Bernardino Contra Costa Fresno Mendocino Yolo Sutter Nevada Humboldt Shasta Yuba Imperial Merced Colusa Glen Tehama Stanislaus San Francisco Kern Butte Tulare Medi-Cal is the percent of adults with diabetes covered by Medi-cal (Medicaid). Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in the general population. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 75

81 California County Comparisons Medicare Rank Rate Lower Age Rate Lower San Joaquin San Benito Solano Santa Clara Monterey Napa Kings Santa Barbara Yuba Los Angeles San Bernardino Mendocino Yolo Alameda California San Mateo San Diego Madera Merced Tulare Sacramento Humboldt Orange Colusa Glen Tehama Marin Riverside Sonoma San Luis Obispo Fresno Stanislaus Santa Cruz Placer Ventura Imperial Contra Costa El Dorado San Francisco Rank Rate Lower Age Rate Lower Butte Kern Lake Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Sutter Shasta Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Nevada Medicare is the percent of adults with diabetes covered by Medicare. Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in the general population. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 76

82 California County Comparisons No usual source of care Rank Rate Lower Age Rate Lower Alpine Amador Butte Calaveras Colusa Fresno Glen Inyo Kings Mariposa Mendocino Mono Nevada San Benito Santa Barbara Shasta Stanislaus Tehama Tuolumne Ventura Contra Costa Riverside San Mateo Humboldt Yolo San Joaquin Sutter Orange Napa Santa Clara Placer Imperial Marin Alameda Yuba El Dorado Merced California San Bernardino Rank Rate Lower Age Rate Lower Sacramento Solano Monterey Sonoma Los Angeles San Luis Obispo Kern Madera San Diego Tulare San Francisco Lake Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Santa Cruz No usual source of care is the percent of adults with diabetes who do not have a regular health care provider. Rank is based on the compared health indicator from the best to worst. = confidence interval Rate is estimate of crude percent rate for the compared health indicator in the general population. Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 Diabetes in California Counties California Census. 77

83 California County Comparisons Obese Rank Rate Lower Age Rate Lower Santa Cruz Nevada Santa Barbara Marin Ventura Mendocino San Mateo San Luis Obispo Kings Tulare Orange Fresno San Francisco Sonoma Santa Clara Los Angeles Alameda Yolo Solano Imperial Yuba Sutter California Napa Lake Shasta Riverside Colusa Glen Tehama San Diego Merced Kern Contra Costa El Dorado San Benito Madera San Joaquin Placer Rank Rate Lower Age Rate Lower Monterey Humboldt Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne San Bernardino Sacramento Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Butte Stanislaus Obese is the percent of adults with diabetes who are obese (BMI > 30). Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in the general population. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 78

84 California County Comparisons Overweight Rank Rate Lower Age Rate Lower Madera Stanislaus San Bernardino Butte Sacramento Santa Clara San Joaquin Contra Costa Yuba Yolo Sutter Colusa Glen Tehama Ventura Los Angeles Orange El Dorado California Riverside Monterey Solano Kern Sonoma San Diego San Francisco Alameda Merced Humboldt San Benito Imperial Nevada Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Rank Rate Lower Age Rate Lower Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Napa Placer Fresno Lake Shasta Marin San Mateo Tulare Santa Barbara Kings San Luis Obispo Mendocino Santa Cruz Overweight is the percent of adults with diabetes who are overweight (BMI > 25). Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in the general population. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 79

85 California County Comparisons Physical inactivity Rank Rate Lower Age Rate Lower Placer Mendocino San Francisco Merced Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Kings Fresno San Luis Obispo San Mateo Yolo San Bernardino Santa Clara San Diego Imperial Lake Orange Alameda Napa Santa Cruz Tulare San Joaquin Humboldt Santa Barbara California Los Angeles Marin Riverside Colusa Glen Tehama Sonoma Solano Shasta Rank Rate Lower Age Rate Lower Madera San Benito Sacramento Stanislaus Monterey Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity El Dorado Kern Nevada Ventura Yuba Butte Contra Costa Sutter Physical inactivity is the percent of adults with diabetes who do not engage any leisure time activity. Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in the general population. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 80

86 California County Comparisons Current smoking Rank Rate Lower Age Rate Lower Mendocino Sutter San Luis Obispo Santa Barbara San Francisco Butte Santa Clara Sacramento Madera El Dorado Contra Costa Placer Alpine Amador Calaveras Inyo Mariposa Mono Tuolumne Sonoma Riverside San Bernardino Marin Lake Yolo San Mateo Tulare Merced Alameda Napa San Diego Kings California San Joaquin Ventura Orange Shasta Kern Solano Rank Rate Lower Age Rate Lower Imperial Humboldt Los Angeles Colusa Glen Tehama Nevada Yuba Fresno Monterey Santa Cruz Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Stanislaus San Benito Current smoking is the percent of adults with diabetes who are currently smoking. Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in the general population. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 81

87 California County Comparisons Uninsured Rank Rate Lower Age Rate Lower Alpine Amador Calaveras Inyo Mariposa Mono Nevada Tuolumne Placer Ventura Merced Butte San Luis Obispo Sacramento Stanislaus Mendocino Sutter Contra Costa Riverside Del Norte Lassen Modoc Plumas Sierra Siskiyou Trinity Shasta Solano San Francisco El Dorado Marin Orange Humboldt Kern Fresno San Mateo San Bernardino Yolo Colusa Rank Rate Lower Age Rate Lower Glen Tehama Santa Clara California San Benito San Joaquin Imperial Sonoma Santa Cruz Napa San Diego Alameda Los Angeles Lake Yuba Tulare Kings Santa Barbara Madera Monterey Uninsured is the percent of adults with diabetes who had no health insurance during the last 12 months. Rank is based on the compared health indicator from the best to worst. Rate is estimate of crude percent rate for the compared health indicator in the general population. = confidence interval Age adjusted rate is the estimate of percent rate with age adjustment based on 2000 California Census. Diabetes in California Counties 82

88 Methodology Data Sources The diabetes prevalence and risk factor statistics included in this report are based on the 2005 California Health Interview Survey (CHIS). (8) Estimates of population sizes at the county level are based on population projection data from the California Department of Finance (CDOF). (9) CHIS is a collaborative project of the University of California, Los Angeles (UCLA) Center for Health Policy Research, the California Department of Public Health, and the Public Health Institute. The survey covers a variety of public health topics, including health status, access to health care, and health insurance coverage. CHIS is the largest state health survey and one of the largest health surveys in the United States. It is a random digit dial telephone survey of California households designed to produce reliable estimates for the whole state, for large and medium-sized population counties, and for groupings of the smallest population counties. CHIS includes data about adults, adolescents, and children from all parts of the state, and is conducted every two years. To capture the diversity of the California population, interviews are conducted in five languages: English, Spanish, Chinese (Mandarin and Cantonese dialects), Vietnamese, and Korean. The first CHIS survey was conducted in 2001 and collected information from more than 55,000 households. Only adult data are used in this report because CHIS does not provide diabetes prevalence and risk factor data at the county level in children and adolescents. CDOF uses a baseline cohort-component method to project population by age, gender, and race/ethnicity. For the projection series , there are seven mutually exclusive race/ethnic groups: Hispanics and non- Hispanic American Indians, Asians, Blacks, Multirace persons, Pacific Islanders, and Whites. A baseline projection assumes people have the right to migrate where they choose and no major natural catastrophes or war will befall the state or the nation. A cohort-component method traces people born in a given year through their lives. As each year passes, cohorts change as specified in the mortality and migration assumptions. New cohorts are formed by applying the fertility assumptions to women of childbearing age. Indicators and Definitions All CHIS indicators used in this report are self-reported. Diabetes and related risk factor indicators used in this report include: Diabetes prevalence, indicating the percentage of people with diagnosed diabetes. Since the data from CHIS are self-report, the actual diabetes prevalence rate is likely to be as much as 68% higher when people with undiagnosed diabetes are considered. (7) Diabetes management data comprising annual rate A1C tests, cholesterol tests, eye exams, foot exams, and flu shots. During the past decade, scientific investigations have established that controlling certain macrovascular risk factors, such as elevated blood lipids and blood pressure, as well as microvascular factors, (10) (11) such as elevated blood glucose, will result in fewer diabetes-related complications. Diabetes risk factor data concerning persons who are current smokers, overweight, obese, do not participate in regular physical activity, or consume less than five servings of fruits and vegetables a day. The Diabetes Prevention Program study has found that lifestyle changes resulting in modest weight loss of 5-7 percent can prevent or delay the development of type 2 diabetes among adults with prediabetes by 58 percent. (4) Health status data comprising history of hypertension, high cholesterol, or heart disease. These health conditions are among the major complications of diabetes and represent a large health care cost in the United States. (12) Access to care data indicating Medicare, Medi-Cal, or no insurance coverage, and having no usual source of health care. The type of insurance and access to health care that an individual has can influence his/her ability to diagnose and treat health problems such as diabetes. Diabetes in California Counties 83

89 Diabetes Prevalence is based on the question: {Other than during pregnancy, has/has} a doctor ever told you that you have diabetes or sugar diabetes? (Yes/No/Borderline or Prediabetes). This question measures the population of adults with self-report diagnosed diabetes. People with undiagnosed diabetes were not included in the estimation. Therefore, the actual diabetes prevalence in California and its counties could be higher. A1C Test is based on the question: About how many times in the last 12 months has a doctor checked you for hemoglobin A one C? (Number of times). These data measure the population of adults with diabetes who had at least one A1C test during the past 12 months. The A1C test shows the average amount of blood glucose (sugar) over the last 3 months. People with diabetes should have an A1C test at least once a year. [Note: recommendations for diabetes care included in this report are based on the Basic Guidelines for Diabetes Care (13), developed by the Diabetes Coalition of California and and aligned with the American Diabetes Association s clinical recommendations for diabetes care. (4) ] Cholesterol Test is based on the question: About how long ago did you have your blood cholesterol checked? (1-12 mo/13mo-2yr/25mo-5yr/5yr +/Never). These data measure the proportion of adults with diabetes who had a cholesterol test during the past 12 months. People with diabetes should have a cholesterol test once a year. Eye Exam is based on the question: When was the last time you had an eye exam in which the pupils were dilated? This would have made your eyes sensitive to bright light for a short time. (Within the past month/ Within the past year/within the past 2 years/2 + years ago/never). These data measure the population of adults with diabetes who had at least one eye exam by a health professional during the past 12 months. Diabetic retinopathy is the leading cause of blindness in the United States. People with diabetes should have a dilated eye exam at least once a year. Annual Flu Shot is based on the question: During the past 12 months, have you had a flu shot? (Yes/No). These data measure the population of adults with diabetes who had a flu shot during the past 12 months. People with diabetes should have a flu shot once a year. Foot Exam is based on the question: About how many times in the last 12 months has a doctor checked your feet for any sores or irritations? (Number of times). These data measure the population of adults with diabetes who had at least one foot exam by a health professional during the past 12 months. Diabetes is the major cause of non-traumatic lower-limb amputation in the United States. Many of these amputations can be prevented with proper foot care. People with diabetes should have a foot exam at least once a year. Current Smoking status is calculated from combining two cigarette-smoking questions. Respondents are first asked if they have smoked 100 or more cigarettes in their entire lifetime; if yes, they are asked if they smoke cigarettes everyday, some days, or not at all. We categorized current smokers as those who had smoked more than 100 cigarettes in their lifetime and now smoke cigarettes every day or some days. These data measure the proportion of adults who are currently smoking. Smoking is a major accelerator for development of diabetes-related complications and may be a risk factor related to the development of diabetes and prediabetes. Smoking is also a contributor to many other serious diseases in the United States. Overweight data measure the population of adults with a Body Mass Index (BMI) greater than or equal to 25. Obese data measure the population of adult people with a BMI greater than or equal to 30. BMI is the ratio of weight (kg) and square of height (m2). CHIS BMI data are based on self-report weight and height measures. Studies have shown that people who are overweight are at much greater risk of developing type 2 diabetes and cardiovascular disease than normal weight individuals. Most people with type 2 diabetes are overweight. In those with prediabetes, the Diabetes Prevention Program showed that increasing moderate physical activity by 30 minutes a day for at least 5 days a week coupled with a 5-7 percent reduction in body weight produced a 58 percent reduction in the onset of diabetes. Diabetes in California Counties 84

90 Physical Inactivity is calculated from a series of CHIS physical activity-related questions. These data measure the population of adults who do not engage in any physical activity, including walking, moderate, or vigorous physical activity. Physical activity is an important health behavior for people with diabetes as it promotes good health and improves diabetes-related outcomes. In those with prediabetes, the Diabetes Prevention Program showed that increasing moderate physical activity by 30 minutes a day for at least 5 days a week coupled with a 5-7 percent reduction in body weight produced a 58 percent reduction in the onset of diabetes. Less than 5-A-Day is calculated from a series of CHIS nutrition-related questions. The data measure the population of adults consuming less than five servings of fruits and vegetables per day. Studies have shown that a diet rich in fruits and vegetables may protect against the development of several chronic diseases and contributes to a healthy weight. For those with diabetes, it is important to have a personalized meal plan that includes consumption of fruits and vegetables. High Blood Pressure is based on the question: Has the doctor ever told you that you have high blood pressure? (Yes/No). These data measure the population of adults who have a history of high blood pressure. High blood pressure is one of the major complications of diabetes. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure, or kidney failure. High Cholesterol is based on the question: The last time your cholesterol was checked, did a doctor tell you your blood cholesterol was high? (Yes/No). These data measure the population of adults who have a history of high cholesterol. High cholesterol is one of the major complications of diabetes that contributes to heart disease and stroke. Heart Disease is based on the question: Has a doctor ever told you that you have any kind of heart disease? (Yes/No). These data measure the population of adults who have a history of any kind of heart disease. Heart disease is one of the major complications of diabetes. Medicare is calculated from a series of CHIS insurance coverage-related questions. The data measure the population of adults covered by Medicare, a federal program that provides health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure. Medi-Cal is calculated from a series of CHIS insurance coverage-related questions. The data measure the population of adults covered by Medi-Cal, California s Medicaid program. It provides health care coverage for more than six million low-income children and families as well as elderly, blind, or disabled individuals. Uninsured is calculated from a series of CHIS insurance coverage-related questions. The data measure the population of adults without continuous health insurance coverage during the past 12 months. Lacking health insurance can make it difficult for individuals to seek medical care for the diagnosis and treatment of diabetes. No Usual Source of Health Care is calculated from a series of CHIS insurance coverage-related questions. The data measure the population of adults who do not have a regular health care provider. Because diabetes is a chronic disease that requires ongoing medical treatment and support, lacking a usual source of health care puts individuals at risk for poor diabetes control and complications. Other Insurance is not included in this report due to space limitations. Other Insurance includes employer-based coverage, private health insurance purchased by individuals, and Healthy Families or other public programs. The rates of other insurance can be extrapolated from the data presented by summing the rates for Medicare + Medi-Cal + Uninsured and subtracting the sum from 100%. Rates of other insurance can also be found at Diabetes in California Counties 85

91 County and Sub-Population In this report, data on diabetes prevalence and risk factors are reported for the state, by county, and by age, race, and gender sub-populations within each county. The county of residence, age, race, and gender from the imputed data are used in this report for the county and sub-population analyses. (14) Smaller population counties are aggregated to obtain reliable statistical estimates. The aggregated counties are grouped as follows: Colusa, Glenn, Tehama Del Norte, Lassen, Modoc, Plumas, Sierra, Siskiyou, Trinity Alpine, Amador, Calaveras, Inyo, Mariposa, Mono, Tuolumne Race sub-groups used in the sub-population analyses include Hispanic/Latino, Asian American (Asian), African American (Black), White, and Other based on the CDOF race category definition. Specifically, in this report the Hispanic/Latino category is the same as the Hispanic category used by CDOF. The White category is the same as the Non-Hispanic White category used by CDOF. The Other category is the combination of Pacific Islanders, Multiple Races, and Non-Hispanic Other categories used by CDOF. The aggregation of the race/ethnic groups in the Other category used in this report is based on sample size considerations at the county level. Age sub-groups used in the sub-population analyses are 18-44, 45-64, and 65+ years of age. The selection of these age subgroups was done to balance the interest in age specific groups (e.g., older adults) with sample size considerations. Statistical Estimation Non-responses to diabetes prevalence and risk factors from the survey data are imputed using the Hot-deck imputation with random sampling with replacement method. The imputation is performed according to the survey design and stratification. The purpose of the imputation is to properly estimate the totals using the weights from the survey data. Non-responses to diabetes prevalence and risk factors include Refused, Don t know, or Not ascertained categories. Group rates are used for smaller counties within the same aggregated county groups. Totals for a small county are proportional to the estimated aggregated group totals based on the county/group demographic proportions. Prevalence and risk estimates were stratified and weighted according to the sampling scheme. Variance estimates were obtained using Taylor series linearization to account for the complex survey sample design and post-survey adjustment. For some counties with smaller populations, very few persons in some sub-population groups responded to the survey. To enhance the reliability of estimates, at least three responses were required for the denominator of all prevalence and risk estimates regardless of the weight assigned to the observations. Both crude rates and age-adjusted rates are included in the county ranking tables. The crude rates are calculated based on the survey data and the age-adjusted rates are weighted according to the 2000 California demographics data. (9) The ranking of the counties by diabetes prevalence is ordered by the crude prevalence rate. All other county ranking tables are ordered by the corresponding crude rates. The 95 percent confidence intervals are the measure of sampling variation. Limitations CHIS 2005 is an excellent data source for county-level diabetes prevalence and risk factors. However, there are some limitations in the areas of diabetes surveillance and prevention. Important diabetes risk factors are omitted from the survey questionnaire such as prevalence of prediabetes, gestational diabetes, and diabetes family history. Health behavior data collected from the survey, such as physical activity and healthy diet, do not directly relate to the measures of lifestyle intervention recommended by the Diabetes Prevention Program. The limitation of survey sample size makes it impossible for some race sub-population analyses at the county level. There are no county-level diabetes prevalence and risk factor data for children and adolescents. Diabetes in California Counties 86

92 References Centers for Disease Control and Prevention. National Diabetes Fact Sheet. US Department of Health and Human Services, Centers for Disease Control and Prevention, National averages used to provide California estimates. Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R, et al. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care. 2007;30: Venkat Narayan KM, Boyle JP, Theodore JT, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003; 290: Knowler WC, Barrett-Conner E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346: American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2005; 28(Suppl 1):S4- S36. Coffey R, Matthews TL, McDermott K. Diabetes Care Quality Improvement: A Resource Guide for State Action. US Department of Health and Human Services, Agency for Healthcare Research and Quality, AHRQ publication No , September Cowie CC, Rust KF, Ford ES, Eberhardt MS, Byrd-Holt DD, Li C, et al. A full accounting of diabetes and prediabetes in the U.S. population, and Diabetes Care Nov 18. [Epub ahead of print]. California Health Interview Survey, Los Angeles, CA: UCLA Center for Health Policy Research, State of California, Department of Finance. Population Projections for California and Its Counties , by Age, Gender and Race/Ethnicity. Sacramento, CA: Department of Finance, July Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329: UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ. 1998;317: American Diabetes Association. Economic Costs of Diabetes in the U.S. in Diabetes Care. 2008;31: Diabetes Coalition of California. Basic Guidelines for Diabetes Care (revised 2008). Retrieved March 18, 2009, from s Web site: cfm?contentid=743. California Health Interview Survey. CHIS 2005 Methodology Series: Report 1 Sample design. Los Angeles, CA: UCLA Center for Health Policy Research, Diabetes in California Counties 87