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Contact Info
Diabetes and Health Behavior Unit
health.diabetes@state.mn.us

Contact Info

Diabetes and Health Behavior Unit
health.diabetes@state.mn.us

Indicator Dashboards
Population-Level Indicators for Monitoring the Picture of Diabetes in Minnesota

Key
  • Improving
  • Stable
  • Getting Worse

These state-level indicators are a set of population-level measures meant to present a broad picture of diabetes in Minnesota. They were chosen by the members of the Minnesota Diabetes Collective Impact Initiative and are to be shared in order to increase understanding of ways diabetes affects many people in our state.

Nearly all of the data shared on this dashboard includes people with both type 1 and type 2 diabetes. For that reason, we describe the data as about diabetes - meaning all people in the state with the disease, regardless of type. If there is information particular to a certain type of diabetes, we have tried to clearly state this.

 
 

Please click on the italicized indicator title to view more information about the indicator including background, data source, rationale for inclusion, and additional data (if available).

Overall Diabetes Indicators

Indicator Date of Most Recent Measure Current Measure
Blood Glucose Screening Rates 202056.10%

Percentage of Minnesota adults between 40 and 70 years of age who are overweight or obese, and who do not have known diabetes, who have been screened for diabetes in the last 3 years.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
A person needs to know that if they have a health condition, they are able to take action, receive quality medical care, and live their healthiest life possible. Because diabetes often has no obvious symptoms, the only way to be diagnosed with diabetes or prediabetes is to have a blood glucose test screening.

Why this indicator was chosen
There are several different guidelines and recommendations for diabetes screening. We chose the 2015 US Preventive Service Task Force (USPSTF) blood glucose screening guideline because it classified diabetes screening as a Grade “B” preventive service, meaning that it is supported by strong scientific evidence. Under the Affordable Care Act, all insurance plans must cover the cost of Grade “B” preventive services. This screening measure is also one we have available data for.

Other organizations have guidelines that include more people, including people younger than 40 years of age and people of normal body weight. For example, the American Diabetes Association recommends screening 1) all adults 45 years and older (regardless of other risk factors) and 2) adults 18 years and older who are overweight or obese and have one or more risk factors for diabetes such as; being of African American, Asian, Latino, or Native American race/ethnicity, having high blood pressure, and other risk factors. The USPSTF guideline recommends that providers consider screening these adults as well. For this reason we also present results for adults 18-40 year old who are overweight or obese.

Data source
The analyses are conducted by the Minnesota Department of Health based on data from the Minnesota Behavioral Risk Factor Surveillance System Data (BRFSS). The survey is a weighted population-based survey of health behaviors of adults 18 years of age and older residing in Minnesota.

Measure Definition
This measure drew from all people who responded ‘no’ or ‘yes, only during pregnancy’ to the question, “Has a doctor, nurse or other health professional ever told you that you have diabetes?" These are people who are considered not diagnosed with diabetes and therefore potentially need screening.

To create our measure, we calculated the proportion of people who responded yes to the question “Have you had a test for high blood sugar or diabetes within the past three years?”
Among all those who:

  • Do not have diabetes (as defined above)
  • Are between 40-69 years of age (the closest we could make the data match the 40-70 year old recommendation)
  • Are overweight or obese

Overall result

Percentage of Minnesota adults between 40-70 years of age who are overweight or obese, who do not have known diabetes, and who have been screened for diabetes in the last 3 years – 56.1% (95% CI: 54.3 - 57.9%).

Additional data related to the indicator (subgroup analyses):

Diabetes screening rates increase with age among adults 40-69 years of age who are overweight or obese

Age* Screening Rate 95% Confidence Interval P-value
40-44 years 45.3% (40.7-49.8%) <0.0001
45-49 years 47.7% (43.3-52.1%)  
50-54 years 54.8% (50.5-59.1%)  
55-59 years 61.4% (57.2-65.7%)  
60-64 years 62.6% (58.9-66.3%)  
65-69 years 66.7% (62.2-71.1%)  

Screening rates also increase with increasing weight (measured by the body mass index) among adults 40-69 years of age who are overweight or obese

Body Mass Index* Screening Rate 95% Confidence Interval P-value
25-29.9 52.1% (49.7-54.6%) <0.0001
30-34.9 57.6% (54.3-60.9%)  
35-39.9 62.6% (57.4-67.7%)  
40+ 72.7% (66.1-79.2%)  

Screening rates were similar among men and women 

Sex* Screening Rate 95% Confidence Interval P-value
Female 54.2% (51.8-56.6%) 0.02
Male 58.6% (56.0-61.2%)  

There was no statistically-significant difference in diabetes screening rates by educational level.

It is difficult to assess whether there are significant differences in screening for diabetes between people from different racial and ethnic groups because the available race or ethnicity-specific rates are based on small numbers.

  • The BRFSS data do not show solid evidence suggesting that screening rates are different between Non-Hispanic Whites and Non-Hispanic Blacks
    • However, the findings are not conclusive because of small numbers
  • Hispanic adults taking the survey did report more frequent screening
Race/ethnicity* Screening Rate 95% Confidence Interval
Non-Hispanic White 56.0% (54.2-57.8%)
Non-Hispanic Black 63.1% (53.3-73.0%)
Hispanic 57.7% (48.0-67.3%)

Finally, we also examined screening rates for adults 18-39 who are overweight or obese.  The guideline suggests screening should be considered for these adults.

Percentage of Minnesota adults between 18 and 39 years of age who are overweight or obese, and who do not have known diabetes, who have been screened for diabetes in the last 3 years– 32.0% (95% CI: 29.5-34.4%).

  1. *Rates were determined for individuals who reported having received or not having received a blood glucose test. For adults 40-69 years old, 3.0% said they did not know if they had been tested as did 1.9% of adults 18-39.
 
 
 
 
 

Other relevant data for interpreting the indicator:
The data represent self-report of blood glucose screening over the last 3 years. People who said they were not screened represent two groups of people:

  • People who did not get their blood glucose levels tested
  • People who were tested, but either did not know or forgot about it at the time they were asked

For more information about national screening rates according to criteria supported by the American Diabetes Association and other recommendations considered by the US Preventive Services Task Force, see Casagrande et al. in the American Journal of Preventive Medicine.  

None

Adults Living with Diabetes20208.8%

Percentage of Minnesota adults who report that a health care provider has told them that they have diabetes.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
This is an essential measure to describing the impact of diabetes on the State of Minnesota. This number shows the percentage of the adult population living with diabetes in the state.

Why this indicator was chosen
This indicator was selected because of its critical importance for understanding the number of people affected by diabetes.

Data source
The data are analyses conducted by the Minnesota Department of Health based on data from the Minnesota Behavioral Risk Factor Surveillance System Data (BRFSS). The survey is a weighted population-based survey of health behaviors of adults 18 years of age and older residing in Minnesota.

Measure Definition
Survey respondents included in the measure were adults who responded yes or no to the question: “Has a doctor, nurse or other health professional ever told you that you have diabetes?" The prevalence was determined by the number of yes responses after excluding responses that they only had diabetes during pregnancy. To calculate diabetes prevalence, the weighted proportion of yes responses among all yes and no responses was determined.

Overall result

Percentage of Minnesota adults who report that a health care provider has told them that they have diabetes – 8.8% (95% CI: 8.3-9.3%).

Additional data related to the indicator (subgroup analyses):

Age is strongly associated with diabetes prevalence (BRFSS 2020)
Age Group Diabetes Prevalence 95% Confidence Interval P-value
18-44 Years 2.7% (2.2-3.2%) <0.0001
45-64 Years 10.1% (9.2-11.0%)  
65+ Years 19.5% (18.1-21.0%)  
There are also differences in prevalence related to sex (BRFSS 2020)
Sex Diabetes Prevalence 95% Confidence Interval P-value
Male 9.7% (8.9-10.4%) <0.01
Female 8.0% (7.3-8.7%)  
Education is also associated with diabetes prevalence (BRFSS 2020)
Educational Attainment Diabetes Prevalence 95% Confidence Interval P-value
Less than high school 10.4% (7.8-13.0%) <0.0001
High school grad/GED 10.6% (9.5-11.7%)  
Some college 9.5% (8.6-10.4%)  
College grad or more 6.4% (5.8-7.1%)  
There are differences by geography across Minnesota (SMART BRFSS 2020)
Metropolitan Statistical Area Diabetes Prevalence 95% Confidence Interval
Minneapolis-St. Paul 8.5% (7.8-9.2%)
Fargo 8.8% (6.6-11.0%)
Duluth 10.7% (7.4-12.8%)

Other relevant data for interpreting the indicator:

Type 1 or Type 2 diabetes: The BRFSS survey question does not ask respondents whether or not they have type 1 or type 2 diabetes. Estimates suggest 90-95% of diabetes cases among adults represent type 2 diabetes.

Diabetes prevalence is increasing: The design of the BRFSS survey was the same over a long period making it possible to compare diabetes prevalence between the mid 1980s and 2010. In Figure 1 smoothed,* age-adjusted** prevalence data are shown. The prevalence of diagnosed diabetes nearly doubled between 1994 and 2010 in Minnesota.1 Similar increases in diabetes prevalence, a nearly three-fold increase, were observed in national data.

  • Chart
  • Table

Percentage of Minnesota Adults with Diabetes

Year*,**

Percentage of Minnesota Adults with Diabetes

Year Percent
1994 3.5
1995 3.9
1996 3.8
1997 4.4
1998 4.5
1999 4.8
2000 4.6
2001 4.7
2002 4.9
2003 5.2
2004 5.4
2005 5.5
2006 5.6
2007 5.6
2008 5.8
2009 6.1
2010 6.2

Many factors likely contribute to the increased prevalence of diabetes. First, people with diabetes are living longer lives, which will increase numbers. In fact, a national study reported that for people with diabetes the rate of death due to any cause declined 23% (95% CI: 10-35%) between 1997-2006.2 Second, changes were made to the criteria used to diagnose diabetes during this period of time. Lower blood sugar levels (particularly fasting blood glucose levels) were included in the range that defined diabetes. This means more people would have glucose levels in the diabetic range, contributing to higher rates of diabetes. Third, there are changes in population demographics. The population in our state is aging and diabetes prevalence increases with age. Also, Minnesota has experienced increases in the proportion of non-white populations, as shown in the table below, who tend to have higher rates of type 2 diabetes:

Race/Ethnicity Percentage of 2010 Minnesota Population3 Percentage Change Between 2000 and 2010[4]
Black or African American Alone 5.2% +59.8%
Asian Alone 4.0% +50.9%
Hispanic or Latino 4.7% +74.5%
White Alone 85.3% +2.8%

Fourth, the increase parallels the rise in obesity rates. Obesity is a risk factor for type 2 diabetes. A risk factor does not necessarily mean a cause of diabetes. Whether it is overall obesity directly that causes diabetes or if obesity is correlated or goes along with other factors (lifestyle or metabolic syndrome for example) that drive diabetes risk is still being worked out. Between 1995 and 2010, BRFSS data showed the obesity rate rose from 15 to 25% across Minnesota.4

  1. Note: The BRFSS survey changed its sampling and weighting strategies so we cannot directly compare data from 2011 or 2012 to data collected before 2011. Assessment of trends will be possible only with additional years of data collected using the new sampling and weighting schemes.

Underestimated prevalence: National data suggest that a significant number of people who have diabetes do not know they have it. Using the most recent data from the National Health and Nutrition Examination Survey, about 10% of all diabetes cases in the US are undiagnosed and not counted in surveys that ask people if their health care provider has diagnosed them with diabetes.5 Assuming these national rates of under-diagnosis are good estimates of rates in Minnesota, the total diabetes prevalence (diagnosed, which is probably captured in BRFSS, and undiagnosed) is likely around 8.5-9% of adults in Minnesota.

  1. *Smoothing refers the fact that the data for each year represent the average of the reporting year and one year before and after.
    **Age-adjusted means that the effect of changes in the age distribution of adults in the state, namely that they are getting older, is removed from the data.

Citations:

  1. Centers for Disease Control and Prevention. National Diabetes Surveillance System.
  2. Gregg, E., et al., Trends in Death Rates Among U.S. Adults With and Without Diabetes Between 1997 and 2006. Diabetes Care, 2012. 35: p. 1252-1257.
  3. Minnesota Demographer website- check reference.
  4. Centers for Disease Control and Prevention., Behavioral Risk Factor Surveillance System Survey Data, 2011, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: Atlanta, Georgia.
  5. Selvin, E et al. 2017 Identifying Trends in Undiagnosed Diabetes in U.S. Adults by Using a Confirmatory Definition. Ann Intern Med. 167(11):769-776

 

Rates of Newly Diagnosed Diabetes20186.1 per 1,000 adults

Rate of new diabetes diagnoses in the adult Minnesota population (18-76 years).

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
This measure is important for describing the growth of diabetes on the State of Minnesota. This number shows the percentage of the adult population who report that they are newly diagnosed with diabetes.

Why this indicator was chosen
This indicator was chosen because it can help explain changes in the number of people living with diabetes, also known as diabetes prevalence. Increases in the number of people living with diabetes can happen for many reasons (see Adults Living with Diabetes indicator above):

  • People with diabetes may be living longer
  • Better identification – we are doing a better job of finding people with undiagnosed diabetes that has been going on for some time, often years
  • People are developing diabetes at a faster rate than before

Data about the number of new diabetes cases can help us better understand if the number of people living with diabetes is increasing because of reasons stated above.

Data source
Data were analyzed by the Centers for Disease Control and Prevention (CDC) using data from the Behavior Risk Factor Surveillance System (BRFSS) and are presented on the state data page of the United States Diabetes Surveillance System. 

Measure Definition
The detailed description of this measure is provided on the methods page associated with the United States Diabetes Surveillance System. First, all people living with diabetes were identified using the question “Has a doctor, nurse or other health professional ever told you that you have diabetes?" 

People who said yes, excluding women who said they had diabetes only in pregnancy, were asked their age at diabetes diagnosis.  Age at diagnosis was subtracted from the person’s age at the time they completed the survey. 

  • If the difference between the two ages was 0, those people were considered newly diagnosed 
  • If the difference between the ages was 1, half of the people were classified as newly diagnosed or incident cases  

Incidence rates were then calculated using the weighted number of adults diagnosed with diabetes in the last year and the weighted number of adults without diabetes in the adult population.

Next, results were age-adjusted or projected onto the 2000 US standard population using age groups of 18-44, 45-64, and 65-76 years of age.  Data presented are smoothed estimates, averaging three years of data, except for 2010 and 2011 which represent averages of 2 years of data. Averaging numbers is used to remove some of the variability in the data so people can see big picture trends better.

Additional data related to the indicator:

Overall result

The rate of new diabetes diagnoses in Minnesota adult population was 6.1 per 1,000 adults (95% CI: 5.3-6.9/ 1,000 adults).

Increases in the overall number of people with diabetes may occur for many reasons:

  • People with diabetes may be living longer
  • Better identification – we are doing a better job of finding people with undiagnosed diabetes that has been going on for some time, often years
  • People are developing diabetes at a faster rate than before

Below is a graph of diabetes incidence rates in Minnesota between 1996 and 2014.   

Note: that rates before 2010 and rates after 2011 are not directly comparable because the survey methodology changed in 2011.

The circles in the graph are point estimates or our best estimates of incidence. Rates ranged between 3.1-6.1 cases per 1,000 adults between 1996 and 2003 and declined from 2007 onward to around 4-4.5 cases per 1,000. The shaded area is the confidence limits for the point estimates. They try to capture how error that comes from asking a small group of people a survey questions might end up affecting our point estimates. The overlapping confidence limits for the estimates show that it hard to determine if increases or decreases are really different or if they just reflect survey error. 

  • Chart
  • Table

Age-Adjusted Diabetes Incidence
Minnesota (1996-2016)**

Rate per 1,000 adults
2011: Change in
survey methodology
|

Year*

*Yearly incidence rates reported in the graph are 3-year averages except for the first and last data point which reflect 2 years of data.
**The shaded area show the upper and lower 95% confidence bounds respectively.

 

Age-Adjusted Diabetes Incidence in Minnesota (1996-2016)**

Year Percent 95% Confidence Level
1996 3.1 2.3 to 4.1
1997 4 3.1 to 5.2
1998 4.6 3.6 to 5.7
1999 4.7 3.7 to 6.0
2000 4.4 3.4 to 5.6
2001 4.3 3.3 to 5.6
2002 5.1 4.1 to 6.5
2003 6.1 4.9 to 7.6
2004 6.1 4.7 to 7.8
2005 5.4 4.2 to 7.1
2006 4.8 3.6 to 6.8
2007 4.0 3.1 to 5.2
2008 5.0 3.1 to 5.3
2009 4.1 3.2 to 5.4
2010 6.5 3.2 to 6.2
2011 5.6 4.5 to 7.0
2012 4.6 3.7 to 5.6
2013 4.1 3.4 to 5.0
2014 4.1 3.5 to 4.8
2015 5.5 4.8 to 6.2
2016 5.6 4.9 to 6.5

The 2018 incidence rates place Minnesota among the states with lowest incidence.1 The national median in 2018 was 7.7 per 1,000 adults.

Other relevant data for interpreting the indicator:
The most recent national data suggest that incidence rates may be slowing in some groups after many years of constant increase.  Overall incidence among US adults stayed around 4 per 1,000 through the 1980s.  In the early 1990s, the rate began to increase through about 2008 when the overall incidence rates began to decline. This decline is not seen in some subgroups including: non-Hispanic blacks and Mexican Americans, adults 20-44 years of age, and adults who have completed a high school education or less. Possible reasons for declining incidence may include: efforts to reduce obesity and the introduction of a new diagnostic test, hemoglobin A1c,2 which can change the baseline for measuring diabetes rates.

Citations:

  1. Centers for Disease Control and Prevention. Diabetes Report Card 2012, 2012, Centers for Disease Control and Prevention, US Department of Health and Human Services: Atlanta, GA.
  2. Geiss, L.S., et al. Prevalence and Incidence Trends for Diagnosed Diabetes Among Adults Aged 20 to 79 years, United States, 1980-2012. JAMA 312(12):1218-1226.
Total Cost of Care for Diabetes2017Est. $4.7 billion

Estimated dollars spent on medical costs due to diabetes in the state of Minnesota.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
This indicator will capture the costs due to diabetes as a whole in Minnesota. Reducing costs for care is one of the Triple Aim goals1 that have been set for medical care in the United States.

Why this indicator was chosen
We lack a regularly updated estimate of total cost of care for diabetes in Minnesota. Instead, we offer a related measure, medical costs attributed to diabetes in Minnesota, which is regularly updated and starts to tell part of the total cost of care story.

Data source
The available cost figures come from studies modeling the costs of diabetes in the United States. The Minnesota estimates came from the Supplementary Tables containing state-level economic costs for diabetes that were published along with the national-level analysis. The results can be found in The Economic Burden of Elevated Blood Glucose Levels in 2017: Diagnosed and Undiagnosed Diabetes, Gestational Diabetes, and Prediabetes. Dall et al. Diabetes Care. Published online 4/2/2019.

Measure Definition
The reported measure describes the additional costs that are a result from living with diabetes. They do not include costs that a person would have regardless if they had diabetes or not. This is not the total cost of care, but is a portion of the total cost of care.

The model uses health care costs from the Medical Expenditure Panel Survey as a main data source, as well as other datasets, capturing health care use and cost – like the Medicare 5% sample Standard Analytical Files. It also uses information from multiple datasets to determine what percentage of health resources used are due to having diabetes. These two numbers – total costs for a particular health resource, and the percentage of health resource used due to having diabetes – are multiplied to determine the costs attributed to diabetes. Estimates are further paired with additional information about demographics and the percentage of people living with diabetes, to calculate national and state-level estimates.

For more information, please see the methods section in Economic Costs of Diabetes in the U.S. in 2012. American Diabetes Association. Diabetes Care 36(4):1033-1046.

 
 

Additional data related to the indicator:

The estimated costs of medical care and lost productivity at work for Minnesota in 2017 was $4.7 billion dollars.2
The estimated $4.7 billion number represents:

  • Estimated excess medical costs: $3.5 billion

This number includes health care expenses specifically for diabetes such as hospital inpatient stays, hospital outpatient care, nursing home care, office visits, emergency room visits, ambulance services, hospice, podiatry charges, costs of diabetic supplies including; insulin, anti-diabetic agents, prescriptions, medical equipment, and supplies.2

Note: These are not the total costs for medical care for people with diabetes. Instead, they are the additional costs that are a result of people having diabetes and do not include costs that a person would have had whether or not they had diabetes.

  • Estimated indirect costs: $1.2 billion

These costs reflect costs or economic losses associated with absenteeism, presenteeism (attending work, but not working at normal capacity), reduced productivity for adults who are not working, unemployment from disability, and early death.2

In the US, the estimated attributable cost of diabetes in 2017 was $327 billion; with $237 billion due to medical costs, and $90 billion to reduced productivity. Excess costs of medications that people with diabetes take amount to 43% of the total medical costs attributed to diabetes. The estimated attributable direct medical and indirect costs of diabetes have increased significantly in the last decade. The total economic costs have increased from $205 billion (in 2017 dollars) in 2007 to $327 billion a decade later.2

Per-person costs for medical costs grew 14% between 2007 and 2017, showing that the increase in total costs is not only due to diabetes becoming more common (increased prevalence). Adjusting for inflation and increased diabetes prevalence, the average total costs (medical + indirect costs) per person grew from $11,700 to $13,247 (in 2017 dollars) between 2012 and 2017.2

 
 
 

Other relevant data for interpreting the indicator:
The Minnesota Department of Health has also completed a preliminary analysis of Chronic Condition prevalence and spending in Minnesota using a new dataset called the All-Payer Claims Database (APCD). In the report, Chronic Conditions in Minnesota, they present estimates of total spending for people with a diagnosis of diabetes. This includes costs due to having diabetes and costs related to other conditions.

Total medical spending for insured Minnesotans who have diabetes was estimated at $5.2 billion dollars in 2012.3

  • Average cost of $16,300 for each insured person who has diabetes3
    • The majority of insured individuals who had diabetes and were in the APCD analysis had at least 1 other chronic illness 
    • We expect people who have diabetes and other chronic conditions to use more health care and to be more likely to appear in the APCD than people with no other chronic conditions, or less severe disease  
  • Per-person annual costs were $16,800 per year for people with diabetes and comorbidities as compared to $5,200 for people with diabetes, but no comorbidities3

These preliminary APCD estimates better reflect total cost of care than the American Diabetes Association estimates and they utilize Minnesota-specific cost data.

Citations:

  1. Institute for Healthcare Improvement. The IHI Triple Aim Initiative.  Released January 2016.  (Accessed 4/27/16) http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
  2. Economic Costs of Diabetes in the U.S. in 2017. American Diabetes Association. 2018. Diabetes Care 41(5):917-928 http://care.diabetesjournals.org/content/41/5/917
  3. Minnesota Department of Health. Chronic Conditions in Minnesota: New Estimates of Prevalence, Cost and Geographic Variation for Insured Minnesotans, 2012.  Released January 2016.  (Accessed 4/18/16) https://www.health.state.mn.us/data/apcd/docs/20160127_chronicconditions.pdf

Diabetes Management and Outcome Indicators

Indicator Data Current Measure
Clinically Measured Diabetes Care Goals

(Optimal Diabetes Care Components*)

2018Rates Below

Proportion of Minnesota adults (18-75 years of age) who have diabetes and receive regular clinical care that:

  • 82.6%Meet blood pressure guidelines (<140/90 mmHg)
  • 99.4%Are prescribed aspirin if consistent with clinical recommendations
  • 69.6%Have hemoglobin A1c levels <8%
  • 84.2%Are tobacco free
  • 88.2%Are prescribed a statin if consistent with clinical recommendations

 

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
These indicators highlight treatment goals for patients with diabetes that are tracked nationally and in Minnesota. Maintaining these goals may help to lower the risk for health problems associated with diabetes like heart disease, stroke, kidney disease including kidney failure, nerve damage, lower-extremity amputations, and eye disease.1 and references therein,2 Performance on these measures shows our progress toward meeting the goal that all Minnesotans with diabetes are well cared for and have good management strategies for diabetes.

Why this indicator was chosen
These indicators were chosen because they reflect some important measures for people with diabetes. These metrics are usually measured in a clinic, but are not solely influenced by the care the clinic provides. The measures are also influenced by the behavior of Minnesotans with diabetes and the resources to support disease management available in their communities. Therefore, the measure represents the combined work of provider, patient, and communities to make sure that all Minnesotans with diabetes can be healthy.

Data source
The data are from the Minnesota Statewide Quality Reporting and Measurement System (Quality Reporting System) at the Minnesota Department of Health for dates of service between January 1 - December 31 for the listed year. 

Minnesota Community Measurement reports present data for all clinics that report to them, which includes clinics in Minnesota and neighboring states. In contrast, the Quality Reporting System receives data only from Minnesota clinics. There may be slight differences in some measures as a result.

Measure Definition
Adults included in this measure:

  • Are 18-75 years of age
  • Have been seen by a physician, physician assistant, or nurse practitioner in family medicine, internal medicine, geriatric medicine or endocrinology at least twice in the last 2 years for visits billable for a diabetes code, and
  • Have seen a provider in the last year for any reason

Please see the Optimal Diabetes Care measurement specifications adopted as a part of the Health Care Quality Measures Adopted Measures Rule for more information.

  1. *Use of these measures by the Minnesota Diabetes Collective Impact Initiative does not imply endorsement of any other interpretation or use of the measures for other purposes by organizations in Minnesota.
 
 
 
 

Additional data related to the indicator (subgroup analyses):

In 2019, 95.9% (95% CI: 93.5-98.3%) of adults 18-74 years of age with diabetes reported having a doctor appointment in the last year. (BRFSS 2019)

Clinically-measured diabetes goals among Minnesota adults are poorer for adults with diabetes who are enrolled in Minnesota Health Care Programs or who pay out-of-pocket for their care.

Clinically Measured Diabetes Goals among MN Adults with Diabetes who Receive Regular Clinical Care Vary, by insurance status (Quality Reporting System data, dates of service 2018) Insurance coverage.
Insurance coverage % at Blood Pressure Goal % at Aspirin Goal % at A1c Goal % at Tobacco-Free Goal % at Statin Goal
Commercial

84

100

68

87

86

Medicare

82

99

76

86

88

MHCP

81

99

62

73

87

None: Self-Pay

78

100

53

82

80

Average of All

83

99

70

84

88

Achievement of clinically-measured diabetes goals varies by the goal. A1c is lower than the other clinical metrics.

When comparing achievement of goals by type of insurance coverage, A1c and tobacco-free goals show the greatest amount of variation across insurance types and the greatest room for improvement. Insurance type is associated with characteristics like; age, income, employment status, and other social determinants that influence the work that providers, individuals, and community members do in managing these clinical goals. 

 

Other relevant data for interpreting the indicator:

To compare to national data, see the following papers:

Ali MK, et al. Achievement of goals in U.S. diabetes care, 1999-2010.  New England Journal of Medicine. 2013;368(17):1613-24. Ali MK, et al. Achievement of goals in U.S. diabetes care, 1999-2010.  New England Journal of Medicine. 2013;368(17):1613-24.

Ali MK et al. A cascade of care for diabetes in the United States: visualizing the gaps. Annals of Internal Medicine. 2014;161(10):681-9.

For related information that looks at the aggregated percentage of adults who meet diabetes care goals, please visit the MN Community Measurement website for the Health Care Quality Report, which presents data by clinic, region of the state and payer, and the Health Equity of Care Report, which stratifies the data by race, Hispanic ethnicity, preferred language, and country of origin, in addition to geography.

Citations:

  1. Ali MK, et al. Achievement of goals in U.S. diabetes care, 1999-2010.  New England Journal of Medicine. 2013;368(17):1613-24.
  2. Wong et al. Cardiovascular Risk Factor Targets and Cardiovascular Disease Event Risk in Diabetes, a Pooling Project of the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study. Diabetes Care. Published online March 29, 2016.

 

Years of Life Lost to Diabetes20187,850

Years of potential life lost, or number of years of life lost before reaching age 75, due to diabetes among all Minnesotans each year.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
Mortality or death rates are a standard indicator used to describe the impact of chronic diseases, like diabetes on populations. When ranked by main cause of death, diabetes is the 7th leading cause in Minnesota .

Why this indicator was chosen
Years of potential life lost (YPLL) was chosen as the mortality indicator because it shows the effect of early mortality due to diabetes more than just number of lives lost. Early deaths are more likely to be preventable.  YPLL is based on the idea that an average lifetime is 75 years of age.  It counts the number of years of life that were lost before the age of 75 for people whose main cause of death was diabetes.

Data source
The data were obtained from death certificates which are available at the Minnesota Department of Health, Health Statistics Portal under the tab ‘Death Queries’. Some analyses were directly run by health officials in the Center for Health Statistics and the Minnesota Department of Health's Diabetes Unit especially for this report.

Measure Definition
YPLL for diabetes was determined by putting all diabetes-related deaths into groups based on age at death.

Each age group under 75 years is assigned a number years lost by people in that age group who died of diabetes. To determine the number of years assigned to each group, the difference between 75 and the age of each person who died is determined. The numbers are lined up from largest to smallest and the one in the middle or median is given to the whole group.

Then, for each age group, the number of deaths are multiplied by the median number of years lost to estimate the YPLL for that age group. The YPLL for each age group between 0-74 years of age is added to get the total number of YPLL due to diabetes.

Death or mortality rates, age-adjusted death rates, and age-adjusted YPLL were determined for analyses comparing death rates and YPLL. Age-adjustment helps to remove differences in age that can occur because of changes in our state (for example, that our average population is aging). Age-adjustment also allows fairer comparisons between groups that may have younger and older populations. These measures were estimated as define the Minnesota Department of Health, Center for Health Statistics Death Query Guide. Estimates were adjusted to the US 2000 Standard Population. 

 
 
 
 

Additional data related to the indicator:
On average, deaths categorized as having diabetes as a primary cause represent between 7,000 and 8,000 years of potential life lost every year in Minnesota over the last 3 years.

  • Chart
  • Table

Years of potential life lost due to diabetes as a primary cause, Minnesota 2005-2018

Years of potential life lost due to diabetes as a primary cause, Minnesota 2005-2018

Year Years of potential life lost due to diabetes 
2005 6400
2006 6555
2007 6235
2008 6200
2009 5602.5
2010 5990
2011 6120
2012 6835
2013 6850
2014 6800
2015 7050
2016 8088
2017 7910
2018 7850

Between 2002 and 2010, mortality rates due to diabetes as a primary cause declined from an age-adjusted rate of 25.9 to 17.7 per 100,000 population. This pattern is evident whether or not the data are age-adjusted. After 2010, the data fluctuate between 18.5 and 20, showing that the decline has stopped and rates appear more level.

  1. Note: Age-adjustment is a statistical method to remove the effect of population aging.
  • Chart
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Mortality rate due to diabetes as primary cause, Minnesota 2005-2018

 
Mortality rate per 100,000 individuals
Year

Mortality rate due to diabetes as primary cause, Minnesota 2005-2018

Year Unadjusted Mortality Rate  Age-adjusted Mortality Rate
2005 24.5% 23.2%
2006 22.3% 21.3%
2007 20.8% 19.6%
2008 20.8% 19.2%
2009 19.4% 17.7%
2010 19.5% 17.7%
2011 22.1% 20%
2012 21.7% 19.1%
2013 21.4% 18.7%
2014 21.7% 18.6%
2015 22.6% 18.6%
2016 23.0% 19.2%
2017 23.5% 19.3%
2018 23.3% 18.8%

Minnesotans who are of African American or American Indian race/ethnicity experience higher rates of years of potential life lost due to diabetes (as a primary cause) than non-Hispanic whites.

Rate of years of potential life lost by race/ethnicity, Minnesota 1998 - 2012

Year

Non-Hispanic
Asian
Non-Hispanic
African America+
Non-Hispanic
American Indian
Non-Hispanic
White
Hispanic
All Races
1998 - 2002 36.9 210.6 463.6 137.1 53.6
2003 - 2007 49.9 225.4 490.5 135.6 93.9
2008 - 2012 70 208.8 452.2 124.6 80.3

 

Rate of years of potential life lost by race/ethnicity, Minnesota 2013 - 2017

Year

Non-Hispanic
Asian
Non-Hispanic
African America+
Non-Hispanic
American Indian
Non-Hispanic
White
Hispanic
All Races
2013 - 2017 92.8 235.6 785.2 142.1 72.3
  1. +African American includes adults who were born in the United States and those who were born in other countries.
    *Age-adjusted rates below mean that the effect of age on death rates was removed through statistical methods.
 

Other relevant data for interpreting the indicator:
+African-American race does not distinguish between adults who were born in the United States and those who were born elsewhere. This is an important limitation in the data since about 24% of black Minnesotans report being foreign-born.1 

The number of deaths attributable to diabetes among foreign-born Minnesotans is too small to calculate separate rates. The percentage of foreign-born, African American Minnesotans reflected in the data above are listed in the table below:

Percentage of African Americans who are foreign born
Year Percentage
1998 - 2002 4.9%
2003 - 2007 10.6%
2008 - 2012 9.1%

Measures that look at data in race or ethnicity groups should be age-adjusted to account for potential differences in the age between groups. A graph included in the data appendix for the Health of Minnesota statewide health assessment and reproduced here demonstrates why:

In Minnesota, African-American, American Indian, Asian, and Hispanic populations tend to be younger than White populations.

 
  • Chart
  • Table

Proportion of population below 18 years or above 65 years of age by race/ethnicity, Minnesota 2011

 

Proportion of population below 18 years or above 65 years of age by race/ethnicity, Minnesota 2011

Race % under age 18 % age 65 and older
African American 38.4% 3.6%
American Indian 35.6% 4.8%
Asian 32.7% 4.6%
Hispanic 40.5% 2.3%
White 22.7% 14%
All Races (statewide) 24.2% 12.9%

Original data from: US Census 2011

Citations:

  1. About Black Minnesotans Report, Prepared for the Council on Black Minnesotans by the MN State Demographic Center, October 2013.
Potentially Preventable Diabetes-Related Hospitalizations2019Rates Below

Rate of hospitalization among adults for:

  • 64 per 100,000Short-term complications of diabetes
    (eg. Hypoglycemia (low blood sugar) or diabetic coma)
  • 62.2 per 100,000Long-term complications of diabetes
    (eg. Eye, neurological or circulatory problems)
  • 27.3 per 100,000Uncontrolled diabetes
  • 9.4 per 100,000 Lower extremity amputations
    (eg. ankle, foot, and leg, but excluding toes)

Rate of hospitalization among children and youth 6-17 years of age:

  • 25.8 per 100,000Short-term complications of diabetes
    (eg. Hypoglycemia (low blood sugar) and diabetic coma)

 

 

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of the indicator
This set of indicators was selected because these hospitalizations could possibly be prevented*. This could minimize the impact of diabetes on the health of individuals, the quality of life of people living with diabetes and those caring for them, and medical and economic costs to the individual and the health care system.

Why this indicator was chosen
The potentially preventable diabetes-related hospitalization indicators are measures that are tracked nationally and target important health outcomes such as hypoglycemic (low blood sugar) events and lower extremity amputations due to diabetes. Potentially preventable hospitalization events are good population-level measures.

They can be affected by:

  • The care a person receives from his/her regular doctor
  • The person’s ability to access the clinic
  • The person’s knowledge about caring for diabetes
  • The kinds of resources in the community that help the person manage diabetes  

Improving these measures is a challenge to provider, patient, and community alike.

Data source
The data were obtained through the Minnesota Hospital Discharge Dataset. The dataset captures hospitalizations for Minnesota residents that happened at Minnesota facilities and hospitals at other states that share data with the Minnesota Hospital Association, the organization that manages the data and makes it available to MDH. Annual population estimates were obtained through the U.S. Census Bureau in collaboration with the National Center for Health Statistics.

Measure Definition
Definitions for the indicators are available through the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators Technical Specifications. Adult measures were age-adjusted to the U.S. 2000 adult standard population weights.

  1. *Note: the language “possibly preventable”. Not all hospitalizations with this name can be prevented. These numbers can be thought of as the highest number of hospitalizations that could possibly be avoided.

Additional data related to the indicator:

Interpreting trends for each of the preventable hospitalization types is made more complicated by the ICD9/ICD10 transition in the fall of 2015. Several measures, particularly the uncontrolled diabetes and pediatric short-term complications measures, have changed as a result of the coding change. For these measures, trend directionality is based only on the years since the ICD-9 to -10 transition.

Prior to the ICD transition, short-term complications rates increased, while the long-term complication rate decreased over the same time period. Because the percentage of adults living with diabetes increased over the same time, it is difficult to know what may be causing an increase. There may be more short-term complications (eg. blood sugars that are way too high or too low and cause severe problems) because more adults are living with diabetes. Other reasons for the increase could be economic stress, which may make it more difficult to buy healthy food. Lack of proper nutrition or changes in diabetes medications could lead to very low blood sugars or hypoglycemic events.

This trend of worsening rates for short-term complications linked to extremely high or low blood sugar like diabetic ketoacidosis, hyperosmolarity and coma is also seen in national data.1 This could be due to changes in how we care for or treat people with diabetes. It could be due to the increasing numbers of people with diabetes across the country. In addition to the ICD transition in 2015, new ICD-10 codes impacting this measure were added late in 2017.  Because of this, we are unable to determine if the increasing trend observed through 2015 has continued.  The addition of these new codes has caused a dramatic increase in the rate for 2018.
 
  • Chart
  • Table

Adult Diabetes Short-Term Complications Admission Rate
Minnesota 2006-2019

 

 

Age and sex-adjusted rate per 100,000 adults

Adult Diabetes Short-Term Complications Admission Rate Minnesota 2006-2019

Year Age and sex-adjusted rate per 100,000 adults Standard Error Crude Rate Crude Standard Error
2006 36.8 1.9 36.4 1.9
2007 36.7 1.9 36.1 1.9
2008 37.1 1.9 36.4 1.9
2009 38.3 1.9 37.6 1.9
2010 39.8 2.0 38.6 1.9
2011 42.9 2.0 41.5 2.0
2012 45.7 2.1 44.3 2.0
2013 48.8 2.2 47.5 2.1
2014 49.6 2.2 48.2 2.1
2015 50.2 2.2 48.7 2.1
2016 45.4 2.1 42.9 2
2017 46.4 2.1 43.9 2
2018 63.6 2.4 61.3 2.3
2019 64 2.4 61.8 2.3

Hospital admissions for long-term complications of diabetes also relate to blood sugars that are poorly controlled, but over a very long period of time. Overtime, uncontrolled diabetes can lead to kidney and eye problems, nerves can lose their ability to feel, and the circulatory system that moves blood to different parts of the body can be weakened.

  • Chart
  • Table

Adult Diabetes Long-Term Complications Admission Rate
Minnesota 2006-2019

Age and sex-adjusted rate per 100,000 adults

Adult Diabetes Long-Term Complications Admission Rate Minnesota 2006-2019

Year Age and sex-adjusted rate per 100,000 adults Standard Error Crude Rate Crude Standard Error
2006 81.3 2.8 83.3 2.9
2007 75.8 2.7 78.1 2.8
2008 71.4 2.6 74.6 2.7
2009 63.3 2.4 66.4 2.5
2010 59.9 2.3 63.7 2.5
2011 60.0 2.3 63.9 2.5
2012 57.0 2.2 61.4 2.4
2013 57.7 2.2 62.8 2.4
2014 53.0 2.1 58.1 2.3
2015 48.6 2 53.9 2.2
2016 45.1 1.9 50.4 2.1
2017 59.1 2.2 66.5 2.4
2018 61.0 2.2 69.1 2.5
2019 62.2 2.2 71.2 2.5

The rate of potentially preventable hospitalizations due to uncontrolled diabetes in adults also decreased by about 35% between 2006 to 2014. Minnesota has lower rates than the United States, but the downward trend has also been seen nationally.2

 
  • Chart
  • Table

Adult Uncontrolled Diabetes Admission Rate
Minnesota 2006-2019

Age and sex-adjusted rate per 100,000 adults

Adult Uncontrolled Diabetes Admission Rate in Minnesota 2006-2019

Year Age and sex-adjusted rate per 100,000 adults Standard Error Crude Rate Crude Standard Error
2006 8.8 0.9 9.0 0.9
2007 11.2 1.0 11.3 1.1
2008 9.4 0.9 9.7 1
2009 9.2 0.9 9.5 1
2010 8.6 0.9 8.9 0.9
2011 9.0 0.9 9.4 0.9
2012 6.4 0.8 6.7 0.8
2013 7.2 0.8 7.4 0.8
2014 5.7 0.7 5.9 0.7
2015 10.1 0.9 10.8 1
2016 26.2 1.5 27.9 1.6
2017 26.0 1.5 28.0 1.6
2018 28.2 1.5 30.7 1.7
2019 27.3 1.5 29.7 1.6

The rate of admission for diabetes-related amputations (feet and legs) appears to be starting to increase. Looking at data through 2000, the rate moves up and down quite a bit, making it harder to see any obvious trends. One clear trend is that amputation rates decreased significantly in the early 2000s for adults 75 years and older. 

We will continue to monitor the data for trends because amputations affect quality of life and, in many cases, they can be prevented. These amputations can be caused by infection, nerves losing the ability to feel, and particular problems with the circulatory system.

  • Chart
  • Table

Adult Diabetes-Related Amputation Admissions Rate
Minnesota 2006-2019

Age-adjusted rate per 100,000 adults

Adult Diabetes-Related Amputation Admissions Rate in Minnesota 2006-2019

Year Age-adjusted rate per 100,000 adults Standard Error Crude Rate Crude Standard Error
2006 10.9 1.0 11.2 11.1
2007 9.4 0.9 9.9 1.0
2008 8.3 0.9 8.8 0.9
2009 8.7 0.9 9.4 1.0
2010 8.7 0.9 9.6 1.0
2011 8.2 0.8 9.0 0.9
2012 8.7 0.9 9.7 1.0
2013 9.4 0.9 10.6 1.0
2014 10.3 0.9 11.7 1.0
2015 9.1 0.8 10.6 1.0
2016 7.7 0.8 8.9 0.9
2017 8.8 0.8 10.2 1.0
2018 9.6 0.9 11.2 1.0
2019 9.4 0.8 11.2 1.0

The admission rate for pediatric short-term complications has decreased by nearly 35% between 2006 to 2014. Nationally, the rate has remained stable.2

  • Chart
  • Table

Pediatric Diabetes Short-Term Complications Rate
Minnesota 2006-2019

Rate per 100,000 age 6-17 years

Pediatric Diabetes Short-Term Complications Rate in Minnesota 2006-2019

Year Rate per 100,000 age 6-17 years Standard Error
2006 32.5 3.8
2007 28.3 3.5
2008 26.7 3.5
2009 28.6 3.6
2010 23.4 3.2
2011 25.9 3.4
2012 23.9 3.3
2013 23.4 3.2
2014 21.3 3.1
2015 23.9 3.3
2016 19.1 2.9
2017 19.5 2.9
2018 19.9 3.0
2019 25.8 3.4

Other relevant data for interpreting the indicator:

For more information and for data that frames all AHRQ-defined potentially preventable hospitalizations, not just ones associated with diabetes, please see the report Potentially Preventable Hospitalizations Among Minnesotans (PDF) from the Health Economics Program at the Minnesota Department of Health.

A recent report from the Health Economics Program at the Minnesota Department of Health on Potentially Preventable Health Care Events in Minnesota looks at the number and cost of potentially preventable emergency department, hospitalization, and re-hospitalization events in Minnesota. It has more discussion of what potentially preventable events are and how they may be prevented. Because it also looks at emergency department data, the report gives a fuller picture of how people interact with health care providers and may help to interpret the data shown here.

  1. Note: this report uses different metrics to define potentially preventable hospitalizations which are different from the AHRQ metrics presented above.

Adult hospitalization rates have been adjusted to the age and sex distribution of the United States population in the year 2000. Crude hospitalization rates are generally slightly higher than age and sex-adjusted rates.

  • Total hospitalization rate for diabetes (2019):  156.6 per 10,000 adults
  • Age and sex-adjusted hospitalization rate for diabetes (2019):  136.5 per 10,000 adults
 
 

Citations:

  1. Agency for Healthcare Research and Quality. 2014. 2013 National Healthcare Disparities Report. AHRQ Publication No. 14-0006.  Agency for Health Care Research and Quality, Rockville, MD. www.ahrq.gov/research/findings/nhqrdr/index.html
  2. Agency for Healthcare Research and Quality. National Quality Indicator Trends, 2000-2012. Accessed via HCUPnet, March 2016. http://hcupnet.ahrq.gov
New Cases of Kidney Failure2018109 per 1,000,000 adults

Number of newly-diagnosed Kidney Failure or End Stage Renal Disease (ESRD) cases in Minnesota among people with diabetes.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
Kidney failure or end-stage renal disease (ESRD) is a severe condition that requires complex management like dialysis or kidney transplant. Treatment has high costs and affects quality of life. Some cases of ESRD are unlikely to be prevented, but some may be preventable.1

Why this indicator was chosen
This indicator shows the number of adults with new diagnoses of ESRD in which diabetes is the main diagnosis. For these people, diabetes is likely or at least partially responsible. Efforts to prevent kidney failure should make this indicator number smaller over time.

Data source
The US Renal Data System collects data related to ESRD and their Data Extraction System for Kidney Related Information & Basic Epidemiology (DESKRIBE) allows the public to run data queries. 

Note: United States Renal Data System. Data Query Tools. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2020.

The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.

Measure Definition
Newly diagnosed individuals with kidney failure or ESRD are identified one of two ways:

  1. A physician certifies the disease on the Center for Medicare and Medicaid Services (CMS) ESRD Medical Evidence form, or
  2. There is evidence of either a kidney transplant or chronic dialysis

The cause of ESRD is listed on the CMS ESRD Medical Evidence Form. The first year patients are included in the USRDS data base they are considered newly diagnosed. For more information see the ESRD analytical methods page of the Annual Data Report.

Additional data related to the indicator:

Many health conditions become more common as we age. Age-adjustment is way to remove the effect of changing population age (aging population or a population getting younger) from the data. Removing age allows us to say if numbers are going up or down over time because of factors that we are more likely to change. Adjusting the data for changes in the racial background of people who have ESRD or changes in the proportion of women and men who have ESRD also can help us to understand changes in the number of new ESRD cases.

  • Chart
  • Table

Age-Adjusted Trends for Incident End-Stage Renal Disease
with Diabetes as the Main Diagnosis, Minnesota Adults (Aged 18+) 2004-2018

 

 

 

New ESRD cases per 1,000,000 Adults

Age-Adjusted Trends for Incident End-Stage Renal Disease with Diabetes as the Main Diagnosis, Minnesota Adults (aged 18+) 2004-2018

Year All ESRD cases All ESRD cases with diabetes
2004 1311.9 426.0
2005 1262.7 400.5
2006 1452.8 484.2
2007 1324.1 415.6
2008 1196.8 371.3
2009 1172.3 373.0
2010 1150.8 366.1
2011 1082.0 313.6
2012 1010.3 309.4
2013 1017.7 310.5
2014 922.5 315.9
2015 995.6 356.5
2016 916.0 361.9
2017 899.9 353.1
2018 884.1 368.2

National adjusted incident ESRD rates increased through the 1980s and 1990s and then leveled off. Starting in 2006, rates began to decline slightly. The pattern in the Minnesota data, shown above, is similar even though our graph only shows data from the last decade.2

Other relevant data for interpreting the indicator:

For more information on ESRD, please see the National Chronic Kidney Disease Fact Sheet or the Annual Data Report from the US Renal Data System.

Some highlights from these reports:

  • 44% of new kidney failure or ESRD cases are believed to be caused by diabetes (have diabetes listed as primary cause by a nephrologist.3 The validity of this report has not been established.)2
  • In 2017 age-, sex-, and race-adjusted incident ESRD rates for the US were 273 per million people per year. In the US, the age-, sex-, and race-adjusted rate of incident ESRD cases with a primary diagnosis of diabetes was 140.2 per million people per year2
  • Incident ESRD is 3x higher for Black/African American than for other races; 1.3-fold higher for Hispanics vs. non-Hispanics2
 
 

Citations:

  1. United States Renal Data System. Data Query Tools. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2019.
  2. Population Data. Minnesota State Demographic Center, Department of Administration. St. Paul, MN, 2021.
  3. United States Renal Data System, 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 20892.
Self-Foot Examinations201953.9%

Proportion of Minnesota adults with diabetes who complete foot examinations daily.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
This indicator was chosen to represent one of the important ways that people living with diabetes take care of themselves at home. Successful diabetes management requires not only good medical care provided by the patients’ health care providers, but also good self-care by the patients themselves.  Routine foot examination for sores and irritation is an important part of diabetes self-care.

Why this indicator was chosen
Regular foot examinations are important for detecting sores or irritations that can become infected and eventually lead to lower extremity amputations, a diabetes complication that has long lasting consequences on daily life.  Amputations can be prevented if sores/irritations are detected early and treated, so that the infection does not develop and progress to require amputation. Amputation rates were reduced by 49-85% when strategies to address foot care and foot ulcers were implemented. This includes preventing sores by using appropriate footwear, educating people with diabetes and their health care providers about performing foot exams, and effectively treating any foot ulcers that are found.1

Data source
The analyses are conducted by the Minnesota Department of Health using data from the Minnesota Behavioral Risk Factor Surveillance System Data (BRFSS). The BRFSS is a population-based self-reported telephone survey of health behaviors and conditions of resident Minnesotans 18 years of age and older. People participating in BRFSS live in their own homes. Individuals in institutionalized settings like nursing homes or college dorms are not included.

Measure Definition
This measure included all people who responded yes to the question, “Has a doctor, nurse or other health professional ever told you that you have diabetes?"  People who responded “yes, only during pregnancy” were not included.

Among adults who reported having diabetes, we determined responses to the question “About how often do you check your feet for any sores or irritations? Include times when checked by a family member or friend, but do NOT include times when checked by a health professional.” For this measure, we reported the (weighted) proportion that responded that they check their feet at least one time per day.

 
 
 
 

Overall results
The proportion of Minnesota adults with diabetes who examine their feet for sores or irritation every day is 53.9% (95% CI: 50.5-57.3%).

Other relevant data for interpreting the indicator:
Information about provider foot-checks:

The BRFSS survey also includes a separate question asking people with diabetes whether or not their health care provider performed a foot check during a clinic visit within the last year. Both self-checks and provider checks are part of a comprehensive diabetes management strategy. That is why we present the other half of the story, what doctors completed, below for your reference.

  • In 2019, 83.0% (95% CI: 80.6-85.4%) of adults with diabetes reported that a provider completed a foot check.

The Healthy People 2020 target for adults with diabetes reporting that their provider completed a food exam is 74.8%. Minnesota has reached this goal. However, there is room for improvement. A person with diabetes should have a comprehensive foot exam by a provider each year to identify risk factors for foot ulcers and amputations.2

Citations:

  1. Bakker K. et al. 2012. Practical guidelines on the management and prevention of the diabetic foot 2011.Diabetes/Metabolism Research and Reviews. 28(S1):225-231.
  2. American Diabetes Association. Microvascular Complications and Foot Care. Diab Care. 39(S1):S72-S80.
Medication Adherence202089.0%

Percentage of Minnesota adults who have diabetes and are enrolled in fee-for-service Medicare who adhere to prescribed blood sugar medication.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
Correctly taking prescribed medication, which is known as medication adherence, is an important part of diabetes self-management for many adults with diabetes. It is important to look at the degree to which people take prescribed medications. There are many types of medications that people with diabetes take to manage their disease and to help prevent the development of complications. A common medication taken is one that controls blood sugar.

Why this indicator was chosen
The indicator we chose looks at medication adherence for people with diabetes who take prescribed blood sugar medications and have Medicare fee-for-service insurance.

  1. Note: This is just one piece of the story of medication adherence for people with diabetes since people often take many medications.

Since diabetes risk increases with age, looking at the Medicare population makes sense. This data only describe people who have Medicare fee-for-service insurance and not people who purchase Medicare Advantage (managed care) plans through private insurers. This means that we cannot describe all people with diabetes on Medicare.

Data source
The data were obtained from the Centers for Medicare and Medicaid Services and are calculated from Medicare Part D Data.
The results apply to the Medicare population enrolled in fee-for-service Medicare. 

  1. Note: In 2016, 55% of Minnesotans are enrolled in Medicare Advantage1 meaning this data reflect only about half of all Medicare enrollees in the state.

Measure Definition
The measure includes adults 18 years of age and older who have been prescribed medications for controlling blood sugar* and have had at least two prescription fills during the year examined**. Adults who have prescriptions filled for 80% or more of the time that they are supposed to be taking the medication were classified as adherent. Full measure details are available through CMS in their Star Ratings Technical Notes: Part C and D Performance Data.

Rates are reported for each individual plan and an overall state rate is calculated. The state rate is the average of individual plan rates reported by Medicare plans servicing fee-for-service enrollees in Minnesota. This is not the average adherence among adults served by fee-for-service Medicare in Minnesota because we do not know the number of people with diabetes who are covered by each plan.

  1. *To be included in this measure, adults with diabetes need to be taking one of the following medications used to control blood sugar: a biguanide, a sulfonylurea, a thiazolidinedione, a DPP-IV inhibitor, an incretin mimetic drug, a meglitinide drug or a SGLT2 inhibitor that regulates glucose.  Insulin is not included in the list of medications for this measure.
    **There is a 1-2 year lag between the claim being filed and data reporting.  For example, data representing medication adherence during 2014 are included in the 2016 Star Ratings Data.
 
 

None

None

Citations:

  1. Medicare Advantage Fact Sheet. Kaiser Family Foundation. Published May 11, 2016. http://kff.org/medicare/fact-sheet/medicare-advantage-fact-sheet/
Kidney Screening201889.3%

Proportion of Minnesota adults with diagnosed diabetes enrolled in managed care insurance plans who have their kidney function checked.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
Kidney disease, or nephropathy, is a common and serious problem among people with diabetes. As many as 1/3 of adults with diabetes experience some decrease in kidney function.1 Diabetes is also the most common cause for chronic kidney disease in the U.S.

The most severe form of kidney disease (end-stage renal disease [ESRD]) is caused by diabetes or hypertension in 7 out of 10 people and requires dialysis or a kidney transplant.2 Early diabetic nephropathy can be diagnosed by a urine test which looks for small amounts of protein in the urine: “urinary microalbumin.”  This test can reveal development of kidney disease before kidney function begins to decrease. Maintaining good control of blood sugar and blood pressure can prevent kidney function from getting worse.1

Why this indicator was chosen
This indicator is one of the measures that Minnesota health insurers need to report to the state. Kidney damage cannot be treated appropriately if it is not diagnosed or routinely assessed. This indicator examines all people with diabetes and includes routine assessments for the prevention or treatment of kidney disease.

Data source
The data are taken from the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures that are required to be submitted to the Minnesota Department of Health for Health Maintenance Organizations (HMO) and Community Based Providers (CBP) annually. HEDIS & Performance Measurement is a set of metrics that are used to determine how well health care services are being delivered. Health insurance plans use this information to find out how health care can be improved. HEDIS measures cover many different health topics including diabetes.

All health insurers serving commercially-insured, Medicaid, or Medicare populations in Minnesota must report this HEDIS measure to the State of Minnesota. Different insurers report data to different agencies. The Minnesota Department of Health receives data from HMOs and CBPs only.

A limitation to this data is that it only describes a small fraction (around 1 in 4) of Minnesotans with diabetes.

Measure definition
The data is presented for the year of service listed. Detailed measure information can be found on the HEDIS website within the Comprehensive Diabetes Care measure. In brief, the measure includes all 18-75 year old adults with type 1 or type 2 diabetes who were enrolled in the reporting insurance plan for the whole calendar year. The measure reports the percentage of insured adults with diabetes who had either:

  • A nephropathy screening test or
  • Had nephropathy based on
    • A documented visit to a kidney specialist
    • A documented renal transplant
    • Treatment for a kidney-related diagnosis
    • A positive test for protein in the urine
    • A prescription for a particular kind of blood pressure medication (ACE/ARB)

For more information, please see refer to the National Quality Measures Clearinghouse: Comprehensive diabetes care: Percentage of members 18 to 75 years of age with diabetes (type 1 and type 2) who received medical attention for nephropathy.

The overall state average rate is calculated by taking a weighted average of each rate reported by all insurance plans that report to the Minnesota Department of Health. To determine rates by the type of health care plan, the weighted average of rates was then determined for all health plans that offered that particular type of coverage. 

 

Currently, kidney screening data is only available for certain parts of Minnesota’s insured population. People included often belong to high risk groups such as; people with low incomes, elderly, and people with disabilities. This data can help us understand where improvements in screening rates are most needed in these groups.  

Additional data related to the indicator (subgroup analyses):

Health Care Plan Type % diabetes population receiving kidney screening or monitoring
Commercial Not reported (only a subset of total population available)
Medicare Advantage Not reported (only a subset of total population available)
Minnesota Health Care Programs 85.3
Minnesota Senior Health Options 94.1

MN Care

Special Needs Basic Care (18-64 year olds)

Special Needs Basic Care (18-64 year olds) - Special Needs Plan

90.5

88.7

90.4

None

Citations:

  1. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. (Page accessed 3/09/2020)
  2. American Diabetes Association. Standards of Medical Care in Diabetes - 2014. Diabetes Care 37(S1):14-80.

Prevention Indicators

Indicator Data Current Measure
Prediabetes Awareness20208.7%

Percentage of Minnesota adults who do not have diabetes, but report that a health care provider told them they have prediabetes.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
Recent estimates suggest around 1 in 3 U.S. adults has prediabetes or blood sugar levels higher than normal, but not quite in the range for diabetes.1 Adults with prediabetes are more likely to develop diabetes than adults who do not have prediabetes. Adults with prediabetes are also more likely to develop other serious health conditions including cardiovascular disease, stroke, and kidney disease than people with normal blood sugars.2 Lifestyle changes, including physical activity, healthy diet, and weight loss may delay or prevent progression from prediabetes to diabetes. National data show only about 1 in 10 adults with prediabetes knows that they have the condition.3

Why this indicator was chosen
This measure shows what percentage of adults in the state know that they have prediabetes. There is no other state-based dataset that can provide this type of estimate. Awareness of prediabetes is an important part of helping people with prediabetes take steps to reverse the condition or delay its progression to diabetes.

Data source
The analyses are conducted by the Minnesota Department of Health based on data from the Minnesota Behavioral Risk Factor Surveillance System Data (BRFSS). The survey is a weighted population-based survey of health behaviors of adults 18 years of age and older residing in Minnesota.

Measure Definition
Two questions in the BRFSS survey are needed to measure prediabetes awareness.  First, this measure includes all people who responded ‘no’ or ‘yes, only during pregnancy’ to the question, “Has a doctor, nurse or other health professional ever told you that you have diabetes?" Second, all adults who said that they did not have diabetes, were then asked the follow-up question, “Have you ever been told by a doctor or other health professional that you have prediabetes or borderline diabetes?“ For this measure, we report the (weighted) proportion of adults that responded yes. Those who said ‘Yes, during pregnancy’ were not included.

 
 
 
 
 
 
 
 
 
 
 

Additional data related to the indicator:

Overall results
Percentage of Minnesota adults who do not have diabetes, but report being told by a health care provider that they have prediabetes – 8.7% (95% CI: 8.2 - 9.3%). This measure does not include adults who have prediabetes, but have not been told they have it nor does it include people who have not been diagnosed. National data suggests that the vast majority of adults with prediabetes are not aware of their condition.

  1. Note: that this is an indicator of awareness, which means it only measures the adults who know they have prediabetes because they were told about it by their health care provider. Many more adults have prediabetes (potentially 1 in 3), but do not know it. An increase in prediabetes awareness does not necessarily mean that more people in Minnesota have prediabetes than before. It could simply mean that a higher percentage knows that they have it.   

Other relevant data for interpreting the indicator:

This article is a recent analysis of National Health and Nutrition Examination Survey (NHANES) data that provides estimates of prediabetes prevalence by each different diabetes screening test and by race/ethnicity: Selvin et al. Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010. Ann Intern Med 160(8):517-25.

 

Citations:

  1. Menke A, et al. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA 2015. 314(10):1021-9.
  2. Tabák AG, et al. Prediabetes: a High-Risk State for Diabetes Development. Lancet 2012. 16:2279-2290
  3. Li YF, et al. Awareness of Prediabetes – United States, 2005-2010. Morbidity and Mortality Weekly Review 2013. 62(11):209-12.
Births with Gestational Diabetes20208.5%

Percentage of births in Minnesota in which the mother had gestational diabetes.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
Gestational Diabetes  Mellitus (GDM) develops during pregnancy. This does not include women who had type 1 or type 2 diabetes before pregnancy. GDM is one of the most important risk factors for developing type 2 diabetes in the future.1,2 Women who had GDM in the past need to be followed closely by their health care providers for developing diabetes. During pregnancy, GDM needs to be treated, either with lifestyle modifications or medications (including insulin), to reduce risk of health problems for both mother and child. Additionally, children whose mothers had GDM during their pregnancy are at greater risk for obesity and possibly diabetes when they grow up.2

Why this indicator was chosen
There are multiple sources of data available to estimate the prevalence of GDM, each with their own limitations.3,4

  • Birth certificate data provides information for all Minnesota births with GDM and is available each year, but the condition is under-reported
  • The Pregnancy Risk Assessment and Monitoring System (PRAMS) contains self-reported GDM diagnosis on a selected group of Minnesota births. GDM was more likely reported in PRAMS data3, but  data is not available after 2011
  • Hospital discharge data contains billing codes for GDM. This data typically captures many of the GDM diagnoses listed within the hospital record

Birth certificate data was chosen for this indicator because this data is the most recent, easily available, and because it is believed to be greatest representative of all Minnesota births.

Data source
The data were obtained from the Minnesota Center for Health Statistics and are derived from Minnesota birth certificate records. 

Measure Definition
Risk factors for pregnancy are documented on the birth certificate, including:

  • Diabetes, pre-pregnancy and
  • Diabetes, gestational

We counted the number of births for which 'diabetes, gestational’ was checked on the birth certificate and divided this by the number of births that occurred in Minnesota that year to determine the proportion of births with gestational diabetes. Births that were not classified as GDM were classified as not having GDM.

 

Overall Result
Percentage of births in Minnesota in which the parent had gestational diabetes – 8.5% (95% CI: 8.2-8.7%). Additionally, 1.2% of births in Minnesota were to people with pre-pregnancy diabetes.

Additional data related to the indicator (subgroup analyses):
Older parents have higher rates of gestational diabetes.

Age of Parent Percentage of births with gestational diabetes 95% Confidence Interval
15-19 Years 3.1% (2.2-4.0%)
20-24 Years 5.3% (4.8-5.8%)
25-34 Years 7.9% (7.7-8.2%)

35-49 Years

12.8% (12.2-13.4%)

Rates of gestational diabetes are highest among Asian parents.

Race Percentage of births with gestational diabetes 95% Confidence Interval
White 7.5% (7.3-7.7%)
Black 9.9% (9.2-10.6%)
American Indian/Alaskan Native 10.7% (8.7-12.7%)

Asian

14.9% (13.9-16.0%)

Rates of gestational diabetes among Hispanic parents are higher than the rates among Non-Hispanic parents.

Ethnicity Percentage of births with gestational diabetes 95% Confidence Interval
Hispanic 11.5% (10.6-12.5%)
Non-Hispanic 8.2% (8.0-8.4%)

For historical trends (1993-2003) related to diabetes-complicated pregnancies, please see Devlin et al. Trends and disparities among diabetes-complicated births in Minnesota, 1993-2003. Am J Public Health. 2008. 98(1):59-62.5

Other relevant data for interpreting the indicator:
PRAMS was identified as an alternate data source. In addition to gestational diabetes, PRAMS also asks about diabetes that the mother had before the start of pregnancy.

  • In Minnesota, 8.8% (95% CI: 7.3-10.7%) of mothers who recently gave birth reported having GDM during their most recent pregnancy. (PRAMS 2011)
  • In Minnesota, 1.4% (95% CI: 0.9-2.4%) of mothers who recently gave birth reported having diabetes prior to the start of their most recent pregnancy. (PRAMS 2011)

Citations:

  1. American Diabetes Association. Standards of Medical Care in Diabetes – 2016. Diabetes Care 2016. 31(S1):1-119.
  2. Malcolm, J. Through the looking glass: gestational diabetes as a predictor of maternal and offspring long-term health. Diabetes Metabolism Research and Reviews 2012. 28:307-311.
  3. DeSisto, CL et al.  Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010.  Prev Chronic Dis. 2014.11:130415.  
  4. Devlin, HM et al. Reviewing performance of birth certificate and hospital discharge data to identify births complicated by maternal diabetes. Matern Child Health J. 2009. 13(5):660-6.
  5. Devlin, HM et al. Trends and disparities among diabetes-complicated births in Minnesota, 1993-2003. Am J Public Health. 2008. 98(1):59-62.
Physical Activity Levels in the Adult Population201919.9%

Proportion of Minnesota adults who meet the following weekly guidelines for physical activity:

  • 25.5% Both aerobic and muscle strengthening recommendations

     

    • 58.5% 150 minutes of aerobic physical activity
    • 36.5% 60 minutes of muscle strengthening activities
  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
Physical activity is important to help control weight, prevent and manage diabetes, reduce heart attacks and strokes, strengthen bones and muscles, improve mental health and moods, and it may help people to live longer.1 Increasing the percentage of adults in Minnesota who get the recommended amount of physical activity is a key strategy to reducing the burden of obesity, prediabetes and diabetes, heart disease, and other chronic health conditions. 

Why this indicator was chosen

  • Current clinical recommendations advocate for increased physical activity for all adults as part of diabetes prevention and diabetes management.2 Multiple clinical trials showed that lifestyle interventions, which include healthy diet and regular physical activity, significantly lower the risk of developing diabetes among people at risk for diabetes, help people with diabetes to have better control of their diabetes, help manage high blood pressure and cholesterol, improve mood and quality of life, and lower health care costs.3,4
  • For people with prediabetes, engaging in physical activity is an important part of preventing or delaying the onset of diabetes.
  • For people with diabetes, physical activity is a key element in improving diabetes control and has many other positive impacts on health including better mood, weight management, lowering blood pressure and increasing HDL-c (i.e., good cholesterol). 


Data source
The Minnesota Department of Health conducted analyses of data from the Minnesota Behavioral Risk Factor Surveillance System Data (BRFSS). The survey is a weighted population-based survey of health behaviors of adults residing in Minnesota.

Measure Definition
People surveyed were asked the question “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?” 

Those who responded yes, were asked an additional series of questions about:

  • The two types of non-work related physical activity that they were most engaged in
  • The amount of time they spent engaging in the activity
  • The intensity of the activity
  • The frequency and duration of the muscle strengthening exercises like yoga, sit-ups, push-ups, lifting weights and use of elastic bands

Based on individual responses to these questions, estimated average levels of aerobic physical activity and muscle strengthening activity per week were calculated.   

 
 
 
 

Overall result
Proportion of Minnesota adults who meet the following weekly guidelines for physical activity:

  • Both aerobic and muscle strengthening recommendations – 25.5% (95% CI: 24.6-26.3%)
    • At least 150 minutes of aerobic activity per week – 58.5% (95% CI: 57.5-59.5%)
    • At least 60 minutes of muscle strengthening activities per week – 36.5% (95% CI: 35.6-37.5%)

Most Minnesota adults report engaging in some physical activity in the last 30 days (not including their job) – 80.1% (95% CI: 79.3-80.9).

Additional data related to the indicator (subgroup analyses):

General Population:
Older adults are less likely to reach overall physical activity targets, mostly because fewer people meet muscle strengthening activity guidelines. (BRFSS data 2019)

Age Group

Meet both aerobic physical activity and muscle strengthening guidelines**

 
 
Meet aerobic physical activity guidelines Meet muscle strengthening guidelines
18-44 years

25.5% (24.1-27.0%)

55.1% (53.35-56.8%)

38.5% (36.9-40.1%)

45-64 years

24.7% (23.3-26.1%)

60.5% (58.9-62.1%)

34.2% (32.6-35.7%)

65+ years

26.7% (25.1-28.3%)

63.2% (61.4-65.0%)

35.3% (33.6-37%)

Overall, men and women meet physical activity goals at similar rates, however slightly more men achieve muscle strengthening goals. (BRFSS data 2019)

Age Group Meet both aerobic physical activity and muscle strengthening guidelines**
 
 
Meet aerobic physical activity guidelines Meet muscle strengthening guidelines
Male

26.7% (25.4-27.9%)

58.9% (57.5-60.3%)

39.0% (37.6-40.4%)

Female

24.3% (26.0-25.5%)

58.0% (56.6-59.5%)

34.0% (32.7-35.4%)

Overall, it is difficult to assess whether there are significant differences in physical activity engagement between people from different racial and ethnic groups because the available race and ethnicity-specific rates are based on small numbers.  However, there appear to be some differences among the racial/ethnic groups with a greater proportion of non-Hispanic whites achieving aerobic physical activity goals as compared with other racial/ethnic groups.

A clear message from the data is that all Minnesotans, regardless of race/ethnicity, can improve their levels of physical activity. (BRFSS data 2019)

Race/ethnicity Meet both aerobic physical activity and muscle strengthening guidelines**
 
 
Meet aerobic physical activity guidelines Meet muscle strengthening guidelines
Non-Hispanic White

25.6% (24.7-26.5%)

60.5% (59.4-61.5%)

36.2% (35.2-37.03%)

Non-Hispanic Black

26.7% (22.0-31.3%)

47.79% (42.8-53.1%)

41.9% (36.8-47.0%)

Asian

28.5% (22.0-35.0%)

53.0% (46.1-60.0%)

39.0% (32.1-45.8%)

American Indian/Alaska Native 23.8% (14.7-32.9%) 53.6% (43.8-63.4%) 33.4% (23.8-43.0%)
Hispanic 19.7% (15.7-23.6%) 42.2% (37.5-46.9%) 30.3% (26.0-34.6%)
Other 25.5% (18.9-32.1%) 56.2% (48.8-63.5%) 43.0% (35.9-50.2%)

Adults with Diabetes:
Adults living with diabetes are less likely to meet physical activity guidelines than adults who did not have diabetes. (BRFSS data 2019)  

Diabetes status Meet both aerobic physical activity and muscle strengthening guidelines**
 
 
Meet aerobic physical activity guidelines Meet muscle strengthening guidelines
Adults with diabetes

19.4% (16.9-22.0%)

51.8% (48.7-54.9%)

29.4% (26.6-32.2%)

Adults without diabetes

26.1% (25.1-27.0%)

59.2% (58.1-60.2%)

37.2% (36.2-38.2%)

P-value <0.0001 <0.0001 <0.0001

Physical activity rates for adults with diabetes did not differ by age (Data not shown) and are lower than rates for adults without diabetes at any age. Rates may be lower for people with diabetes for many reasons.

  1. *NR- Not reportable; does not meet minimum cell size for reporting.
    **95% Confidence Interval.
 
 
 

None

Citations:

  1. Centers for Disease Control and Prevention. Physical Activity and Health webpage. Accessed 8/26/2016.
  2. American Diabetes Association. 2016. Standards of Medical Care in Diabetes – 2016. Diabetes Care. 39(S1):S1-S106.
  3. Knowler et al. 2002. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. NEJM. 346(6):393-403.
  4. Dutton GR and Lewis CA. 2015. The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus. Prog. Cardiovasc. Dis. 58(1):69-75.
Availability of a Personal Provider202093.1%

Percentage of Minnesota adults with diabetes who have a personal doctor/health care

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
People living with diabetes have better health outcomes when they have access to medical care and when they have regular care with a particular provider or team. This is because regular care providers or teams1 get to know the patient’s individual needs, circumstances, and preferences and as a result are more likely to deliver proactive, timely, efficient, and effective care.

Why this indicator was chosen
Our group wanted to determine whether or not people living with diabetes have a personal doctor/health care provider/care team and if they are regularly seen by this individual or team. This measure does tell us if people feel they have a personal doctor and it is easily available. Unfortunately, it does not tell us if a person sees this doctor.

Data source
The analyses are conducted by the Minnesota Department of Health using data from the Minnesota Behavioral Risk Factor Surveillance System Data (BRFSS).  The BRFSS is a population-based self-reported telephone survey of health behaviors and conditions of resident Minnesotans 18 years of age and older.

Measure Definition
This measure included all people who responded yes to the question, “Has a doctor, nurse or other health professional ever told you that you have diabetes?"  People who responded “yes, only during pregnancy” were not included.

Among adults who reported having diabetes, we determined responses to the question “Do you have one person you think of as your personal doctor or health care provider?”  For this measure, we reported the (weighted) proportion that responded yes.

 

Overall result
Percentage of Minnesota adults with diabetes who have a personal doctor/health care provider – 93.1% (95% CI: 91.5-94.8%).

Adults with diabetes were more likely to have a personal doctor/health care provider than adults without diabetes for adults of all ages. (BRFSS 2020)

Age Group Diabetes Status Percentage who have a personal doctor/health care provider P-value
18-44 years

Adults with diabetes

Adults without diabetes

80.6% (72.2-89.0%)

64.8% (63.3-66.3%)

0.003

45-64 years

Adults with diabetes

Adults without diabetes

94.5% (92.7-96.4%)

81.1% (79.8-82.4%)

<0.0001

65+ years

Adults with diabetes

Adults without diabetes

95.4% (93.5-97.3%)

90.7% (89.6-91.9%)

0.001

More than 90% of male and female adults living with diabetes reported having a personal doctor/health care provider or health care team. (BRFSS 2020) 

Sex Diabetes Status Percentage who have a personal doctor/health care provider P-value
Male

Adults with diabetes

Adults without diabetes

92.3% (89.9-94.7%)

67.4% (66.1-68.8%)

<0.0001

Female

Adults with diabetes

Adults without diabetes

94.1% (91.9-96.4%)

82.2% (81.1-83.3%)

<0.0001

These are higher rates than reported by adults who do not have diabetes, especially men who do not have diabetes. 

While we cannot examine the proportion of adults who have a personal doctor/health care provider or health care team who regularly receive clinical care from this team, we do know the proportion of adults who saw any provider (not necessarily the same provider that they identify as being their personal provider) in the last year specifically for diabetes management.

  • 92.7% (95%CI: 91.0-94.4%) of adults with diabetes saw a doctor or health care provider in the last year for their diabetes. (BRFSS 2020)

 

None

Citations:

  1. Coleman et al. Evidence on the Chronic Care Model in the new millennium. Health Aff (Millwood). 2009. 28:75-85.
Depression Among Adults with Diabetes202023.7%

Percentage of Minnesota adults with diabetes who report ever being diagnosed with depression.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
Mental health problems related to diabetes are very complex and important to address. People with mental health issues often have higher rates of diabetes and other chronic conditions.1 Mental health problems, including depression, can significantly impact the lives of people living with chronic conditions like diabetes.1 A person’s mental health can influence their ability to care for themselves, lead a healthy lifestyle, follow recommended treatments, and their physical health (which can then affect their mental health). 

Why this indicator was chosen
Depression is the most common mental health condition among adults with diabetes, affecting between 10 and 20% of people with the disease.2 Depression appears to be more common as diabetes becomes more complex.2 Like other mental health conditions, depression can strongly influence the ability of people with diabetes to manage their disease, lead a healthy lifestyle, and adhere to recommended treatments.2,3 There are many treatment options available for depression,3 and treating depression may help improve diabetes control, overall well-being, and quality of life. It is therefore important to identify depression among people living with diabetes and to ensure people have access to the help and services they need to be healthy.

Data source
The Minnesota Department of Health conducted analyses of data from the Minnesota Behavioral Risk Factor Surveillance System Data (BRFSS). The survey is a weighted population-based survey of health behaviors of adults 18 years of age and older residing in Minnesota.

Measure Definition
This measure includes all people who responded yes to the question, “Has a doctor, nurse or other health professional ever told you that you have diabetes?" People who responded “yes, only during pregnancy” were not included.

Among adults who reported having diabetes, we then determined responses to the question “(Ever told) you that you have a depressive disorder, including depression, major depression, dysthymia, or minor depression?”  For this measure, we report the (weighted) proportion of people who responded yes.

 
 
 
 
 

Overall result
Percentage of Minnesota adults with diabetes who report ever being diagnosed with depression – 23.7% (95% CI: 21.3-26.1%).

Additional data related to the indicator:

Depression is more common among adults with diabetes than adults without diabetes. (BRFSS 2020)

Diabetes Status Ever diagnosed with depression** P-value
Adults with diabetes 23.7 (21.3-26.1%) <0.001
Adults without diabetes 19.4% (18.6-20.2%)  

Both men and women with diabetes tend to report a depression diagnosis more frequently than men and women who do not have diabetes. (BRFSS 2020)

Sex Diabetes Status

Ever diagnosed with depression**

P-value
Male

Adults with diabetes

Adults without diabetes

18.1% (15.1-21.2%)

13.0% (12.0-13.9%)

<0.001
Female

Adults with diabetes

Adults without diabetes

30.2% (26.4-34.1%)

25.6% (24.4-26.9%)

0.02

Adults under 65 years of age are more likely than older adults to report ever being diagnosed with depression. Also, for all age groups, adults who have diabetes are more likely to report ever being diagnosed with depression than adults without diabetes. (BRFSS 2020)  

Others have noted a differences in rates of reporting depression diagnoses by age groups.1

The rates may differ because of:

  • Differences in recall of events occurring over the lifespan between the groups
  • Differing beliefs about mental illness and differences in the likelihood of a group to visit a doctor or mental health professional for diagnosis and treatment
  • Other differences between people in different age-groups (in medical terms, a cohort effect2)
Age* Diabetes Status Ever diagnosed with depression** P-value
18-44 years

Adults with diabetes

Adults without diabetes

34.7% (25.6-43.9%)

22.6% (21.3-24.0%)

0.0037
45-64 years

Adults with diabetes

Adults without diabetes

28.4% (24.3-32.5%)

18.5% (17.3-19.8%)

<0.0001
65+ years

Adults with diabetes

Adults without diabetes

17.6% (14.7-20.5%)

13.4% (12.1-14.7%)

0.0062

**95% Confidence Interval.
 
 
 
 
 
 
 

Other relevant data for interpreting the indicator:
Studies examining treatment of people who have diabetes and depression show that treatment can make depression better.  Many of these studies have also studied hemoglobin A1c levels to see if treatment also can better control a patient’s blood sugar.  A recent review of scientific papers on the subject found that some studies find a better A1c levels among people with diabetes who had their depression treated and some did not.3

There may be many reasons for this:

  • We may need studies that develop interventions to address depression and how people manage their diabetes to see consistent results3
  • Some studies may have included people with more severe depression who could have benefited more from the interventions as compared to studies that enrolled people with more mild symptoms3
  • We may not be looking for the right outcome or we should look at a variety of outcomes and not just A1c. In addition to A1c, outcomes such as hospitalization, symptoms, or quality of life could be examined to determine if treating depression resulted in better outcomes3

 
Another reference to consider to learn more about differences in depression rates by age-group: Depression as a disease of modernity: explanations for increasing prevalence by BH Hidaka.

 
 

Citations:

  1. Health and Human Services, Office of Disease Prevention and Health Promotion. Mental Health. www.HealthyPeople.gov/2020/leading-health-indicators/2020-lhi-topics/Mental-Health  Accessed 6/27/2016.
  2. Snoek et al. 2015. Constructs of depression and distress: time for an appraisal. Lancet Diab and Endocrinol. 3:450-460.
  3. Markowitz,SM. Et al. 2011. A Review of Treating Depression in Diabetes: Emerging Findings.  Psychosomatics. 52:1-18.
  4. Heo, M. et al. 2008. Population projection of US adults with lifetime experience of depressive disorder by age and sex from year 2005 to 2050. Int J Geriatr Psychiatry. 23(12):1266-1270.
  5. Ed. Last, JM. 2001. A Dictionary of Epidemiology, Fourth Edition. New York, New York. Oxford University Press.
Participation in Daily Activities by Adults with Diabetes202030.2%

Percentage of Minnesota adults with diabetes who reported limitations to their usual activities for 7 or more days in the last month as a result of poor physical or mental health.

  • Description
  • Additional Analyses
  • Background/Resources
  • Citations

Importance of indicator
This measure assesses an important part of a person’s quality of life – the ability to do one’s usual activities without being limited by poor physical or mental health. This indicator is important because it tries to capture aspects of people's lives that are important to their everyday activities and living. Often groups of diabetes indicators focus on numbers (such as how many people have diabetes, the cost of diabetes care, and diabetes management) and leave out measures that begin to describe the quality of life for people with diabetes. This measure was meant to be a first step in the direction of having a quality of life measure.  

Why this indicator was chosen
This indicator captures the limitations on normal life activities caused by any health problem, physical or mental. Although this indicator does not capture all aspects of a person’s life, it does reflect the ability to perform daily activities that are important to them. 

  1. Note: We do not know if these limitations to daily activities are actually caused by the diabetes or if they are more common among patients with diabetes for another reason. Whatever the reason for the limitation, it is important to determine if people with diabetes experience limitations more often than people without diabetes and if these limitations are significantly affecting their quality of life.

Data source
The Minnesota Department of Health conducted analyses of data from the Minnesota Behavioral Risk Factor Surveillance System Data (BRFSS). The survey is a weighted population-based survey of health behaviors of adults residing in Minnesota.

Measure Definition
This measure included all people who responded yes to the question, “Has a doctor, nurse or other health professional ever told you that you have diabetes?"  People who responded “yes, only during pregnancy” were not included.

Among adults who report having diabetes, we determined responses to the question “During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, or recreation?” For this measure, we report the (weighted) proportion that said their activities had been interfered with for 7 or more days over the total number of respondents.

Overall result
Percentage of Minnesota adults with diabetes who reported limitations to their usual activities for 7 or more days in the last month as a result of poor physical or mental health – 30.2% (95% CI: 26.4-34.0%).

Adults living with diabetes are nearly twice as likely to report limitations in their daily activities compared to people without diabetes. (BRFSS 2020)

Diabetes Status Had limitations to their activities for 7 or more days in the last month** P-value
Adults with diabetes

30.2% (26.4-34.0%)

<0.0001

Adults without diabetes

18.1% (17.0-19.2%)

<0.0001

Both men and women living with diabetes experience limitations to their daily activities more often than people who do not have diabetes. (BRFSS 2020)

Sex Diabetes Status Had limitations to their activities for 7 or more days in the last month** P-value
Male

Adults with diabetes

Adults without diabetes

27.6% (22.5-32.7%)

15.0% (13.4-16.5%)

<0.0001
Female

Adults with diabetes

Adults without diabetes

32.9% (27.4-38.4%)

20.3% (18.8-21.9%)

<0.0001

Adults with diabetes were more likely to experience limitations in daily activities than those without diabetes across all age groups. (BRFSS 2020)

  1. Note: This data is not age-adjusted and there may still be unaccounted for differences in the average age of adults with diabetes and adults without diabetes that contribute to the differences observed. The uncertainty in the percentages make it hard to say exactly how much more common it is for adults with diabetes to experience these limitations.

 

Age* Diabetes Status Had limitations to their activities for 7 or more days in the last month** P-value
18-44 years

Adults with diabetes

Adults without diabetes

26.3% (15.4-37.2%)

17.4% (15.8-19.0%)

0.07
45-64 years

Adults with diabetes

Adults without diabetes

33.1% (27.5-38.7%)

18.5% (16.6-20.3%)

<0.0001
65+ years

Adults with diabetes

Adults without diabetes

28.8% (23.1-34.6%)

20.4% (17.8-23.0%)

0.005

**95% Confidence Interval.

None

None

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Tags
  • diabetes
Last Updated: 12/29/2022

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