Diabetes is the percentage of adults who have been told by a health professional that they have diabetes, excluding pre-diabetes and gestational diabetes. Diabetes was changed in the 2011 Edition from a supplemental measure to an outcome measure to account for the impact of treating and managing chronic diseases in the U.S. The ranks are based on the preceding year’s data from CDC’s Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS telephone survey has traditionally been completed by people using landlines. During the fielding of the 2011 BRFSS, the methodology was updated to include cellular telephones due to the large number of households that contain only cellular telephones and no landline telephones. Because of these changes, estimates of diabetes prevalence from the 2012 Edition onward cannot be compared to estimates from previous years. Shifts in estimates from previous years may be the result of the new methods, rather than measurable changes in the percentages.
Diabetes is often an outcome of an unhealthy lifestyle and increases one’s risk of developing many other diseases and complications. There are three major types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes. Of these, type 2 diabetes accounts for 90 to 95 percent of all cases. Type 2 diabetes is a largely preventable progressive disease that is managed through lifestyle modifications and health care interventions. It is a major cause of heart disease and stroke as well as the leading cause of kidney failure, non-traumatic lower-limb amputations, and blindness in adults. Overall it is the seventh leading cause of death in the U.S. and contributes to the first and third leading causes of death, stroke and heart disease respectively. Direct medical costs for type 2 diabetes exceed $100 billion and account for $1 of every $10 spent on medical care in the U.S.
Studies have shown that the onset of type 2 diabetes can be prevented through weight loss, increasing physical activity, and improving dietary choices.- Type 2 diabetes is associated with numerous modifiable risk factors such as smoking, obesity, physical activity, and diet which make it an ideal target for prevention. The National Diabetes Prevention Program was created to bring evidence-based interventions to prevent diabetes to communities across the country. More information on prevention is available at www.cdc.gov/diabetes/projects/prevention_program.htm. Additional diabetes information is available at the National Center for Chronic Disease Prevention and Health Promotion, CDC (www.cdc.gov/diabetes/ and www.cdc.gov/nccdphp/publications/aag/ddt.htm) and the American Diabetes Association (www.diabetes.org/).
 Centers for Disease Control and Prevention (CDC). National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States. 2011.
 Heron M. Deaths: Leading causes for 2007. National Vital Statistics Reports; vol 59, no 8. Hyattsville, MD: National Center for Health Statistics. 2011.
 American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care. 2008;31(3):596-615.
 Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
 Tuomilehto J. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343.Top of Form
 Schulze MB. Primary prevention of diabetes: What can be done and how much can be prevented? Annu Rev Public Health. 2005;26(1):445.Bottom of Form
The measures tracked by America's Health Rankings are those actions that can affect the future health of the population. For a state to improve the health of its population, efforts must focus on these measures, these determinants of health.
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