A Healthier Future for West Virginia - Healthy People 2010
WV HP 2010
Federal 2010 Initiative



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5 - Diabetes

Objectives | References


The 2010 goals for diabetes care in West Virginia focus on the following challenges: increasing the demand for better diabetes care through public awareness; increasing early detection of Type 2 diabetes; improving management of diabetes care; increasing the collection of statewide diabetes data; and monitoring and evaluating the effectiveness of diabetes care statewide. Overall, the main goal is to increase the quality of life for persons with diabetes living in West Virginia.

Diabetes is a significant public health issue in West Virginia. Data from the Behavioral Risk Factor Surveillance System (BRFSS) survey indicate that, as of 1997, an estimated 88,635 persons had been diagnosed with diabetes, representing 6.3% of all West Virginian adults. West Virginia's obesity rate as self-reported by respondents to the 1998 BRFSS survey was 43%, the highest in the nation. That same year, 70.0% of adult West Virginians reported having a sedentary lifestyle. West Virginia's median age is 37.6, the oldest in the nation. An estimated 577,300 West Virginians are at increased risk for diabetes due to these risk factors.

Convincing evidence shows that diabetes prevalence continues to escalate nationwide in a costly and devastating manner, primarily due to lifestyle changes. Negative changes in eating habits, meals containing higher levels of fat, and the ever-increasing consumption of fast foods are resulting in the occurrence of obesity at younger-than-ever ages. Physical activities are frequently being replaced by sedentary lifestyles, exacerbating the obesity problem. A large percentage of West Virginians live in very rural areas, with limited access to health care. Education and income levels remain low, contributing to less-than-desirable health care outcomes. These factors are creating a diabetes epidemic. Diabetes is a major disease challenge for both persons with diabetes and their health care providers.

Diabetes is more common among certain racial and ethnic populations. According to the BRFSS, from 1996-1998, 17.2% of African-American women were diagnosed with diabetes, compared with 6% of Caucasian women. Nine percent (9.4%) of African-American men were diagnosed with diabetes, compared to 6.3% of Caucasian men. Diabetes-related death rates are higher among the minority populations as well. The death rate in West Virginia for African-American males with diabetes is 68.8% while the death rate for white males is 32.8%. The death rate for African-American females is 57.4% as compared to 30.8% for white females (BRFSS).

The majority of persons with diabetes have Type 2 diabetes, with approximately 5%-10% having Type 1. Some of the early but vague symptoms are fatigue, blurred vision, and irritability. Complications from diabetes include damage to small and large blood vessels, damage to nerves, and decreased ability to fight infections. A woman with diabetes who gives birth is more likely than other women to have an infant who has congenital anomalies or dies within the perinatal period. A person with diabetes is more likely to have cardiovascular problems, including heart attacks and strokes, lower extremity amputation, kidney problems, and blindness, than persons without diabetes; Persons with diabetes are two to four times more likely to develop heart disease or to suffer a stroke. An estimated 60% to 65% of the diabetes population suffers from hypertension. Over one-half of lower extremity amputations occur among persons with diabetes. Nerve problems occur in 60% to 70% of persons with diabetes. Diabetes continues to be the leading cause of new adult blindness, as well as end-stage renal disease. According to the National Healthy People 2010 goals, "Both type 1 and type 2 diabetes have a significant genetic component. For type 1 diabetes, genetic markers that indicate a greater risk for this condition have been identified; they are sensitive but not specific. Type 2 diabetes, especially in vulnerable racial and ethnic groups, may be associated with a ‘thrifty gene.' Family and twin studies demonstrate considerable influence of genetics for Type 2 diabetes, but a specific genetic marker for the common variety of Type 2 diabetes has not been identified."

Diabetes is a family disease. It requires behavior modification and adaptions that involve not only the person diagnosed but immediate family as well. It requires education, self-care management techniques, dietary and lifestyle changes. Diabetes is a costly disease that requires increased medical visits, medication and/or supplies, and education.

Recent research has been completed that reveals the benefits of near-euglycemic management. This means that with near- normal blood glucose levels, persons are less likely to develop some of the complications commonly associated with diabetes. This may prevent or delay complications of micro-vascular origin. It is essential that health care providers remain knowledgeable and share up-to-date information and treatment guidelines with their patients.

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The Objectives

OBJECTIVE 5.1. Reduce perinatal mortality in infants of mothers with diabetes to no more than 12 per 1,000 births. (Baseline: 14.6 per 1,000 births from 1990-1999)

Data Source: West Virginia Bureau for Public Health (WVBPH), Office of Epidemiology and Health Promotion (OEHP), Health Statistics Center (HSC)

Pregnant mothers need to be instructed in meal planning and how to do blood glucose monitoring. Insulin is often required during pregnancy to attain adequate blood glucose control. Diabetes control is achievable when families have the needed professional assistance from their health care providers and if they have adequate financial resources. Expectant mothers are usually motivated to achieve the best outcome.

OBJECTIVE 5.2. Reduce the frequency of major congenital malformations in infants of mothers with diabetes to no more than 15 per 1,000 births. (Baseline: 26.5 in 1997)

Data Source: WVBPH, OEHP, HSC

Reduction of major congenital malformations in infants includes pre pregnancy counseling and planning for the pregnancy after near-normal blood glucose levels are achieved. Careful monitoring needs to be continued during pregnancy. With pre pregnancy planning and tight control of blood glucose levels congenital malformations are equal to those of mothers without diabetes.

OBJECTIVE 5.3. Reduce the frequency of lower extremity amputations to 15 per 1,000 persons with diabetes. (Baseline: 20 per 1,000 persons with diabetes in 1992-95)


It is estimated that half of lower extremity amputations can be prevented. Persons with diabetes need to be taught to be assertive and remove their shoes and socks at each physician visit. They need to incorporate checking their own feet into their daily routines and reporting any noted problems. Also, they need to be made aware that it is recommended that their health care provider complete a comprehensive foot exam annually.

OBJECTIVE 5.4. Decrease the incidence of end-stage renal disease (ESRD) requiring dialysis or transplantation to no more than 253 per 1,000,000 population. (Baseline: 337 per 1,000,000 population in 1998)

Data Source: Mid-Atlantic Renal Coalition (MARC), contractor for ESRD Network 5

Decreasing the prevalence of end-stage renal disease due to diabetes requires critical attention to blood pressure control. It is currently recommended that blood pressures stay below 130/85. It is also important to evaluate the micro albuminuria and ensure that safe levels are maintained. The importance of maintaining good blood glucose levels in order to prevent kidney disease needs to be emphasized.

OBJECTIVE 5.5. Increase to at least 90% the proportion of patients with diabetes who annually obtain lipid assessment (total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride). (Baseline: 87.1% in 1997)


It is highly recommended that persons with diabetes obtain lipid assessments annually. Optimal care of persons with diabetes includes intensive glycemic control, proper nutrition, physical activity, smoking cessation, and weight control. Medical management, including that of co-morbid conditions, will actualize improved outcomes and decreased cost of diabetes and its complications.

OBJECTIVE 5.6. Increase to 85% the proportion of persons with diabetes who have a glycosylated hemoglobin measurement at least once a year.
(Baseline: 15.9% in 1998)


The HgA1c is the gold standard for diabetes care. To help prevent diabetes complications, the HgA1c should be maintained at 7% or below according to the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS) findings.

OBJECTIVE 5.7. Increase to 73% the proportion of persons with diabetes who have an annual dilated eye exam. (Baseline: 65.5% in 1998)


Annual eye exams are important because diabetes is the primary cause of adult blindness. Serious eye problems can be prevented and treatments such as laser surgery or vitrectomy can be performed to save eyesight.

OBJECTIVE 5.8. Increase to 55% the proportion of persons with diabetes who perform self-blood-glucose monitoring (SBGM) at least daily. (Baseline: 50.3% in 1998)


Every person having diabetes needs to be performing self-blood-glucose monitoring at least daily. This technique enables people to make intelligent decisions based on facts. Each person who checks his or her blood glucose should record it and share it with the health care provider. SBGM can show patterns and heighten awareness of where persons can change exercise routines and eating habits to feel better. One of the barriers to success in SBGM is the need for health care providers to understand more fully the reimbursement issues.

OBJECTIVE 5.9. Increase to 52% the proportion of persons with diabetes who have received diabetes education in the past year from someone other than their physician, such as a registered dietician or certified diabetes educator. (Baseline: 29.5% in 1997)


Diabetes is a condition that persons need to self-manage. Almost all of diabetes management is done outside of the physician's office. It is imperative that people have a good knowledge base so that they can make appropriate decisions.

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Meeting the Objectives

Health Promotion Channels for Achieving Objectives:

  • Worksites
  • Schools
  • Public Health Programs
  • Networks
  • Health Care System Higher Education

The West Virginia Bureau for Public Health, Division of Health Promotion's Diabetes Control Program is the entity leading the initiatives to reach the objectives.

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Work Group Members

Peggy J. Adams, RNC, MSN, CDE, Work Group Leader, Program Manager, WV Diabetes Control Program, WVBPH
Charles Fouty, Concerned citizen
Janice Greene, RN, BSN, Certified School Nurse
Thomas Griffith, OD
Jeff Hamrick, PharmD, CDE, CareLink Health Plans, Director of Pharmacy
Eloise Hollen, RD, CDE, Davis Memorial Hospital
Robert Kefferstan, PhD, WVNET
Judy McGill, RNC, MS, Disease Management Control, CareLink Health Plans
Sharon Murray, MSN, RN, CDE, Department of Family Medicine, Robert C. Byrd Health Sciences Center, West Virginia University (WVU)
Charlotte Nath, RN, EdD, CDE, Department of Family Medicine Robert C. Byrd Health Sciences Center, WVU
Doris Payne, Concerned citizen
Celeste Peggs, MS, RD, LD, WV Department of Education, Office of Child Nutrition
Cecil Pollard, Office of Health Services Research, Robert C. Byrd Health Sciences Center, WVU
Leesa Prendergast, Health Promotion Specialist, Region 7, WVU Coliseum
David Nau, PhD, MS, Dept. of Pharmaceutical Systems and Policy, Robert C. Byrd Health Sciences Center, WVU
Charles Schade, MD, MPH, West Virginia Medical Institute
Frank Schwartz, MD, Endocrine Diagnostics
Rebecca Schmidt, MD, Department of Medicine, Section of Nephrology, WVU
Jeremy Davidson, Concerned citizen
Guy Hornsby, PhD, CDE, School of Medicine, Exercise Physiology, WVU

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Centers for Disease Control, Diabetes Surveillance, 1997 (p. 71).

National Center for Chronic Disease Prevention and Health Promotion, National Diabetes Fact Sheet. November 1, 1998.

West Virginia Bureau for Public Health. Behavioral Risk Factor Survey 1997. Charleston, WV: West Virginia Department of Health and Human Resources, 1998.

West Virginia Bureau for Public Health. West Virginia Vital Statistics 1998. Charleston, WV: West Virginia Department of Health and Human Resources, March 1999.

For More Information

Diabetes Control Program
Office of Epidemiology and Health Promotion
Room 319
350 Capitol Street
Charleston, WV 25301-3715
Phone: (304) 558-0644; Fax: (304) 558-1553


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This page was last updated June 13, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov