Diabetes Deaths

Why Is This Important?

In 2020, diabetes was the 7th leading cause of death for New Mexicans and the 7th leading cause in the U.S. In 2020, Coronavirus disease was the third leading cause of death in New Mexico. This pushed diabetes from sixth leading cause of death in previous years, to seventh leading cause of death in 2020. Diabetes complications, which are costly to individuals, families and to society, include premature death, cardiovascular disease, blindness, end stage kidney disease, and lower extremity amputations. People with diabetes are two to four times more likely to develop cardiovascular disease and stroke; about 65% of deaths in people with diabetes nationwide are due to these conditions. Costs of diabetes extend beyond medical costs, such as costs due to lower productivity, disability and loss of productive life due to premature death, and care-taking by family members. Effective and accessible diabetes prevention and management programs and resources are necessary to reverse the increasing rates of diabetes in our communities and reduce diabetes complications.

Definition

The diabetes death rate: the number of deaths attributed to diabetes per 100,000 people, age-adjusted to the 2000 U.S. population (except for rates by age group). Diabetes deaths include those with ICD10 codes E10 - E14 and as underlying cause of death.

Data Sources

• New Mexico Death Data: Bureau of Vital Records and Health Statistics (BVRHS), Epidemiology and Response Division, New Mexico Department of Health.
  (https://www.nmhealth.org/about/erd/bvrhs/vrp/)
• Centers for Disease Control and Prevention, National Center for Health Statistics, CDC WONDER Online Database
  (http://wonder.cdc.gov)
• New Mexico Population Estimates: University of New Mexico, Geospatial and Population Studies (GPS) Program.
  (http://gps.unm.edu/)

How the Measure is Calculated

How Are We Doing?

Diabetes Mortality rates for both New Mexico and the U.S. in 2020 were far below the HP 2020 target of 66.6 deaths per 100,000 population. New Mexico age-adjusted diabetes death rate was 29.2/100,000 in 2020, down from 34.6/100,000 in 2003. National age-adjusted rates, 25.5/100,000 in 2003 and 24.8/100,000 in 2020, have been lower than that of New Mexico. The number of New Mexico diabetes deaths (i.e., numerator) ranged from a low of 500 in 2000 to a high of 795 deaths in 2020. Recall, though, that the rate has declined. The increase in number of deaths is largely due to population increase. From 2000 to 2020, an annual average of 628 diabetes deaths occurred, with a total of 13,186 diabetes deaths over that 21 year period. In 2020, the age-adjusted rate for females, 24.6/100,000, was statistically significantly lower than that for males, 34.1/100,000. This relationship varied, somewhat, by age group, however, as rates for males did not always differ significantly from that of females across age groups, even using three years of combined data, 2018-2020. Race/Ethnicity Rates: During the 3-year period 2018-2020, the New Mexico American Indian population had the highest age-adjusted diabetes death rate, 71.1/100,000, and the Asian/Pacific Islander and white populations had the lowest diabetes death rates, 16.2/100,000 and 17.2/100,000, respectively. The American Indian rate was over 4 times that of the Asian/PI and white populations, more than double the rates of the Hispanic population, 33.0/100,000, and and nearly double that of the population with the second highest death rate, the Black/African American population, 39.3/100,000. When looking at the race/ethnicity rates by sex, the rates among males was higher than those of females within all groups except Asian/Pacific Islanders and Black/African Americans, where there was not a significant difference between males and females. Among males, the American Indian/Alaska Native and Black/African American rates were four and two times higher, respectively, than the rate among white males. The male American Indian rate was more than two times higher than the male Hispanic rate and nearly two times the male Black/African American rate. Among females, the American Indian/Alaska Native rate was more than four times higher than the white rate, and nearly two times higher than the Hispanic and Black/African American rates. The rate among Hispanic females was twice the rate among white females. All these differences were statistically significant. Urban/Rural: Counties were categorized into Metropolitan, Small Metropolitan, Mixed Urban-Rural, and Rural. In 2018-2020, the diabetes death rate was highest Mixed Urban-Rural category ... 36.0/100,000. The rate for the Metro category was lower than Small Metro, 27.9/100,000 and Mixed Urban-Rural, 36.0/100,000.

How Do We Compare With the U.S.?

From 2000 to 2020, New Mexico rates were between 15% and 25% higher than the U.S. rates. Poverty is a significant determinant of illness and death in any population. New Mexico poverty rates have been higher than the US for many decades. The long and complex history of racial and ethnic discrimination in New Mexico and the U.S. has had a profound effect on American Indian, Black/African American, and Hispanic communities in New Mexico, affecting health status in many ways, including limited access to the healthiest foods, access to health care, and access to stable and well-paying employment.

What Is Being Done?

The NM Department of Health Diabetes Prevention and Control Program (DPCP) works with health care providers and community partners, agencies and coalitions to provide multiple diabetes prevention and management services and programs. Services and programs include: professional development trainings and resources for diabetes prevention and management; the National Diabetes Prevention Program (National DPP), a proven community-based physical activity and nutrition intervention to prevent or delay diabetes in persons at high risk; community resources to help people manage their diabetes through skill building, such as the Chronic Disease Self-Management and Diabetes Self-Management Education Programs; Kitchen Creations cooking schools; and health system disease management interventions that improve blood glucose, blood pressure, and cholesterol. The DPCP provides education, information, and resources about prediabetes and diabetes, particularly to health care providers, to increase screening, testing and referral to prevention and management programs. This includes a centralized referral and data system that helps providers easily make referrals to the above programs. DPCP's partners support built environment improvements so people at risk for or with diabetes can be physically active and initiatives that increase access to healthy foods. Both are essential components of effective population-based diabetes prevention and control. The DPCP consults with populations that are disproportionately affected by diabetes and/or those that serve them to develop programs and services that are culturally appropriate for these populations.

Evidence-based Practices

Diabetes and its complications can be prevented, delayed and/or managed through participation in evidence-based programs, including the National Diabetes Prevention Program's Lifestyle Change Program (provided in a clinical, community, or web-based setting), the Diabetes Self-Management Education Program (provided in a community or web-based setting), and Diabetes Self-Management Education and Support programs (usually provided in a clinical setting). Engaging New Mexicans at high risk of diabetes with evidence-based prevention and management programs is proven to improve health outcomes and reduce the burden of diabetes including mortality. The following New Mexico Department of Health activities are in alignment with Centers for Disease Control and Prevention guidelines and best practices for diabetes control as recommended by the American Diabetes Association, The American Medical Association and the Association for Diabetes Care and Education Specialists: 1. Increase utilization of the National Diabetes Prevention Program's Lifestyle Change Program to prevent or delay the onset of type 2 diabetes among people at high risk by raising awareness about prediabetes, increasing Lifestyle Change Program delivery sites, facilitating the screening, testing and referral of eligible adults at high risk for diabetes to evidence-based programs, and increasing the participation of priority populations in Lifestyle Change Programs among Native American, Rural, Spanish-speaking and people experiencing disabilities or experiencing overweight/obesity. 2. Increase access to sustainable self-management education and support services, including Diabetes Self-Management Education Programs and Diabetes Self-Management Education and Support Programs to improve control of A1C, blood pressure, and cholesterol, by supporting delivery sites with resources to sustain programs, investing in referral systems to connect individuals from priority populations to programs and developing messaging and materials to reach diverse populations with culturally-relevant health promotion and outreach. 3. Implement evidence-based health systems interventions that support high-risk adults to prevent or manage diabetes and related chronic conditions, and help New Mexicans improve control of their A1C, blood pressure, and cholesterol. Health system interventions include initiating bi-directional referrals through electronic health records, the promoting utilization of A1C standing orders, expanding team-based care approaches to include Community Health Workers and creating workgroups with statewide clinical partners to provide trainings and technical assistance to implement health system interventions. 4 Identify and plan quality improvement activities with healthcare organizations that are working to improve health outcomes for people with and at risk for diabetes. Support healthcare organizations to improve quality of care through use of the Planned Care Model, Patient Centered Medical Home, and Electronic Health Record. Within these organizations, support policy and protocol implementation that institutionalize and help sustain quality care improvements. 5. Promote the sustainability of Community Health Workers (CHWs) and Pharmacists involved in providing diabetes prevention, diabetes management and Medication Therapy Management services. 6. Indirectly support Nicotine Cessation programs.

Other Objectives

New Mexico Community Health Status Indicator (CHSI)

Available Services

- The Paths to Health New Mexico platform is an initiative that includes several prevention and self-management programs. These programs are designed to help adults gain the skills and confidence they need to better prevent or manage chronic health conditions or injuries. These programs have been proven to work and to improve quality of life. For more information, visit Home - Paths to Health NM at https://www.pathstohealthnm.org/. - Technical assistance to clinics and primary care providers to implement population-based strategies that support system changes that improve health outcomes (e.g. A1C, blood pressure, LDL cholesterol and smoking cessation) for New Mexico's most vulnerable populations. - Support for community-based prevention and management initiatives such as the National Diabetes Prevention Program, Diabetes and Chronic Disease Self-Management Programs, and Kitchen Creations cooking schools, for people with diabetes. - Analysis, interpretation, and dissemination of data on prediabetes, diabetes, cardiovascular disease, demographics, health behaviors, and access to health care. - Online training modules focused on chronic disease, high blood pressure, and high cholesterol are offered at no charge to New Mexico residents. All trainings are offered in English and Spanish with an opportunity to receive CEU's for successful completion. - Diabetes education and outreach in areas that are underserved or identified as priority populations. For more information on programs or services provided by the NM Department of Health, Diabetes Prevention and Control Program, go to https://www.nmhealth.org/about/phd/pchb/dpcp/.

More Resources

NM Department of Health, Diabetes Prevention and Control Program, go to https://www.nmhealth.org/about/phd/pchb/dpcp/. National Diabetes Prevention Program: https://www.cdc.gov/diabetes/prevention/Index.html Evidence-based lifestyle interventions for preventing type 2 diabetes for communities https://www.cdc.gov/diabetes/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdiabetes%2Findex.htm 1. CDC Wonder, Diabetes Mellitus Mortality Rates, by Year: https://wonder.cdc.gov/Deaths-by-Underlying-Cause.html. 2. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html 3. Diabetes Report Card 2019: https://www.cdc.gov/diabetes/library/reports/reportcard.html Fact Sheets on Physical Activity: www.cdc.gov/nccdphp/sgr/fact.htm Diabetes Data and Trends: https://www.cdc.gov/diabetes/data/index.html 4. Guide To Community Preventive Services [information on community-level evidence-based practices]: Diabetes State Burden Toolkit: https://nccd.cdc.gov/Toolkit/DiabetesBurden National Diabetes Education Program: www.ndep.nih.gov/ US Preventive Health Task Force (clinical preventive services): https://www.thecommunityguide.org/content/guide-clinical-preventive-services-0 5. American Diabetes Association: https://www.diabetes.org/ 6. American Diabetes Association 2021 Standards of Care: https://professional.diabetes.org/content-page/practice-guidelines-resources