# 5 {#section .Chapter-# .unnumbered}

# Diabetes

5-1 Diabetes education

5-2 New cases of diabetes

5-3 Overall cases of diagnosed diabetes

5-4 Diagnosis of diabetes

5-5 Diabetes deaths

5-6 Diabetes-related deaths

5-7 Cardiovascular disease deaths in persons with diabetes

5-8 Gestational diabetes

5-9 Foot ulcers

5-10 Lower extremity amputations

5-11 Annual urinary microalbumin measurement

5-12 Annual glycosylated hemoglobin measurement

5-13 Annual dilated eye examinations

5-14 Annual foot examinations

5-15 Annual dental examinations

5-16 Aspirin therapy

5-17 Self-blood-glucose-monitoring

+---------------------+------------------------------------------------+
| 5-1. Increase the   |                                                |
| proportion of       |                                                |
| persons with        |                                                |
| diabetes who        |                                                |
| receive formal      |                                                |
| diabetes education. |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 17.14 (Diabetes and Chronic Disabling          |
| 2000 Objective**    | Conditions), age adjusted to 2000 standard     |
|                     | population.                                    |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 45 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons aged 18 years and older who  |
|                     | report that they have ever been diagnosed with |
|                     | diabetes and have taken a course or class in   |
|                     | diabetes self-management.                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 18 years and older who  |
|                     | report that they have ever been diagnosed with |
|                     | diabetes.                                      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   Have you ever taken a course or class in   |
|                     |     how to manage your diabetes yourself?      |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | \[For females:\]                               |
|                     |                                                |
|                     | -   Other than during pregnancy, have you EVER |
|                     |     been told by a doctor or health            |
|                     |     professional that you have diabetes or     |
|                     |     sugar diabetes?                            |
+---------------------+------------------------------------------------+
|                     | \[For males:\]                                 |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     health professional that you have diabetes |
|                     |     or sugar diabetes?                         |
|                     |                                                |
|                     |     Yes\                                       |
|                     |     No\                                        |
|                     |     Borderline\                                |
|                     |     Don't know\                                |
|                     |     Refused                                    |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered to have diabetes if     |
|                     | they respond "yes" to either of the two        |
|                     | questions listed above in the denominator      |
|                     | section. Those who respond "borderline" are    |
|                     | not included. Women who report that the only   |
|                     | time they have been diagnosed with diabetes    |
|                     | was during pregnancy (gestational diabetes)    |
|                     | are also excluded.                             |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---+--------------------+---+----------------------------------------------+---+
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|   |                    | : |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   During the past 12 months did any one in |   |
|   |                    |   |     the family ([read names]{.underline})    |   |
|   |                    |   |     have diabetes?                           |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | \[If yes:\]                                  |   |
|   |                    |   |                                              |   |
|   |                    |   | -   Who was this?                            |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   When was diabetes first noticed?         |   |
|   |                    |   |                                              |   |
|   |                    |   |     \(1\) Within the past 2 weeks\           |   |
|   |                    |   |     (2) 2 weeks to 3 months\                 |   |
|   |                    |   |     (3) Over 3 months to 1 year\             |   |
|   |                    |   |     (4) Over 1 year to 5 years\              |   |
|   |                    |   |     (5) Over 5 years                         |   |
+---+--------------------+---+----------------------------------------------+---+
|   | **Expected         |   | Annual.                                      |   |
|   | Periodicity**      |   |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   | **Comments**       |   | Respondents who reported that the diabetes   |   |
|   |                    |   | was first noticed within the past year       |   |
|   |                    |   | (responses 1 through 3 listed above) are     |   |
|   |                    |   | considered to have been diagnosed with       |   |
|   |                    |   | diabetes in the past 12 months.              |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | The measure uses a 3-year moving average to  |   |
|   |                    |   | reliably report data for select population   |   |
|   |                    |   | groups that have small sample sizes.         |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | NHIS was redesigned in 1997. Diabetes        |   |
|   |                    |   | incidence questions were not included in the |   |
|   |                    |   | 1997 or 1998 data collection years. The 1999 |   |
|   |                    |   | NHIS includes questions on diabetes          |   |
|   |                    |   | incidence.                                   |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Data are age adjusted to the 2000 standard   |   |
|   |                    |   | population. Age-adjusted rates are weighted  |   |
|   |                    |   | sums of age-specific rates. For a discussion |   |
|   |                    |   | on age adjustment---see Part A, section 5.   |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | See Part C for a description of NHIS and     |   |
|   |                    |   | BRFSS and Appendix A for focus area contact  |   |
|   |                    |   | information.                                 |   |
+---+--------------------+---+----------------------------------------------+---+

+---------------------+------------------------------------------------+
| 5-3. Reduce the     |                                                |
| overall rate of     |                                                |
| diabetes that is    |                                                |
| clinically          |                                                |
| diagnosed.          |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 17.11 (Diabetes and Chronic Disabling          |
| 2000 Objective**    | Conditions) (also 2.24), age adjusted to the   |
|                     | 2000 population.                               |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 1,000 population (age adjusted---see  |
|                     | Comments).                                     |
+---------------------+------------------------------------------------+
| **Baseline**        | 40 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons who report ever being        |
|                     | diagnosed with diabetes.                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons.                             |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[For children under 18 years:\]               |
|                     |                                                |
|                     | -   Has a doctor or health professional told   |
|                     |     you that {sample child} has any of these   |
|                     |     conditions?                                |
|                     |                                                |
|                     |     \[List of conditions includes diabetes\]   |
+---------------------+------------------------------------------------+
|                     | \[For adults 18 years and older:\]             |
|                     |                                                |
|                     | \[For females:\]                               |
|                     |                                                |
|                     | -   Other than during pregnancy, have you EVER |
|                     |     been told by a doctor or health            |
|                     |     professional that you have diabetes or     |
|                     |     sugar diabetes?                            |
+---------------------+------------------------------------------------+
|                     | \[For males:\]                                 |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     health professional that you have diabetes |
|                     |     or sugar diabetes?                         |
|                     |                                                |
|                     |     Yes\                                       |
|                     |     No\                                        |
|                     |     Borderline\                                |
|                     |     Don't know\                                |
|                     |     Refused                                    |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Adults are considered to have diabetes if they |
|                     | respond "yes" to either of the two questions   |
|                     | listed above. Those who respond "borderline"   |
|                     | are not included. Women who report that the    |
|                     | only time they have been diagnosed with        |
|                     | diabetes was during pregnancy (gestational     |
|                     | diabetes) are also excluded.                   |
+---------------------+------------------------------------------------+
|                     | Children are considered to have diabetes if    |
|                     | the adult proxy respondent reports that they   |
|                     | have ever been told by a doctor that the child |
|                     | has diabetes.                                  |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted rates are weighted    |
|                     | sums of age-specific rates. For a discussion   |
|                     | on age adjustment, see Part A, section 5.      |
+---------------------+------------------------------------------------+
| **Comments**        | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 5-4. Increase the   |                                                |
| proportion of       |                                                |
| adults with         |                                                |
| diabetes whose      |                                                |
| condition has been  |                                                |
| diagnosed.          |                                                |
+=====================+================================================+
| **National Data     | National Health and Nutrition Examination      |
| Source**            | Survey (NHANES), CDC, NCHS.                    |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 68 (1988--94).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 20 years and older who   |
|                     | report that they have ever being diagnosed     |
|                     | with diabetes.                                 |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 20 years and older who   |
|                     | have a fasting blood glucose level of 126      |
|                     | mg/dl.                                         |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1988--94 National Health and          |
| Obtain the National | Nutrition Examination Survey:                  |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you ever been told by a doctor that   |
|                     |     you have diabetes or sugar diabetes?       |
+---------------------+------------------------------------------------+
|                     | \[For female, if yes:\]                        |
|                     |                                                |
|                     | -   Were you pregnant when you were told that  |
|                     |     you had diabetes?                          |
+---------------------+------------------------------------------------+
|                     | -   Other than during pregnancy, has a doctor  |
|                     |     ever told you that you have diabetes or    |
|                     |     sugar diabetes?                            |
+---------------------+------------------------------------------------+
| **Expected          | Annual, beginning with 1999 data.              |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered to have diabetes if     |
|                     | they respond that they have ever been told by  |
|                     | a doctor that they have diabetes or sugar      |
|                     | diabetes. Women who report that the only time  |
|                     | they have been diagnosed with diabetes was     |
|                     | during pregnancy (gestational diabetes) are    |
|                     | excluded.                                      |
+---------------------+------------------------------------------------+
|                     | The undiagnosed population with diabetes is    |
|                     | based on the American Diabetes Association     |
|                     | criteria.**^1^**                               |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHANES and     |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  -----------------------------------------------------------------------
  5-5. Reduce the        
  diabetes death rate.   
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Adapted from 17.9 (Diabetes and Chronic
  Objective**            Disabling Conditions), age adjusted to the 2000
                         standard population.

  **Measure**            Rate per 100,000 population (age adjusted---see
                         Comments).

  **Baseline**           75 (1997).

  **Numerator**          Number of deaths due to diabetes (ICD-9 code
                         250) reported as the underlying or multiple
                         cause of death.

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Diabetes-related mortality data are derived from
                         the multiple-cause-of-death files. Data include
                         all mentions of diabetes on the death
                         certificate, whether as an underlying or a
                         multiple cause of death. Diabetes is
                         approximately three times as likely to be listed
                         as multiple cause of death than as underlying
                         cause.**^2^**

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         This objective differs from Healthy People 2000
                         objective 17.9, which adjusted the death rates
                         using the 1940 standard population. See Appendix
                         C for comparison data.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  ---------------------- ------------------------------------------------
  5-6. Reduce            
  diabetes-related       
  deaths among persons   
  with diabetes.         

  **National Data        National Vital Statistics System (NVSS), CDC,
  Sources**              NCHS; National Health Interview Survey (NHIS),
                         CDC, NCHS.

  **State Data Sources** National Vital Statistics System (NVSS), CDC,
                         NCHS; Behavioral Risk Factor Surveillance System
                         (BRFSS), CDC, NCCDPHP.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000 population (age adjusted---see
                         Comments).

  **Baseline**           8.8 (1997).

  **Numerator**          Number of deaths due to diabetes (ICD-9 code
                         250) reported as the underlying or multiple
                         cause of death.

  **Denominator**        Number of persons who report that they have ever
                         been diagnosed with diabetes.

  **Population           U.S. resident population; U.S. civilian,
  Targeted**             noninstitutionalized population.

  **Questions Used To    For denominator, see Questions Used To Obtain
  Obtain the National    the National Data provided with objective 5-3.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The numerator and denominator of this measure
                         refer to slightly different populations. The
                         numerator includes all U.S. residents; the
                         denominator includes only the U.S. civilian,
                         noninstitutionalized population.

                         Adults are considered to have diabetes if they
                         respond "yes" to either of the two questions
                         listed in the denominator section of objective
                         5-3. Those who respond "borderline" are not
                         included. Women who report that the only time
                         they have been diagnosed with diabetes was
                         during pregnancy (gestational diabetes) are also
                         excluded.

                         Children are considered to have diabetes if the
                         adult proxy respondent reports that they have
                         ever been told by a doctor that the child has
                         diabetes. See Questions Used To Obtain the
                         National Data for objective 5-3.

                         Diabetes-related mortality data are derived from
                         the multiple-cause-of-death files. Data include
                         all mentions of diabetes on the death
                         certificate, whether as an underlying or a
                         multiple cause of death. Diabetes is
                         approximately three times as likely to be listed
                         as multiple cause of death than as underlying
                         cause.**^2^**

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion of age
                         adjustment, see Part A, section 5.

                         See Part C for a description of NVSS and BRFSS
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  5-7. Reduce deaths     
  from cardiovascular    
  disease in persons     
  with diabetes.         

  **National Data        National Vital Statistics System (NVSS), CDC,
  Sources**              NCHS; National Health Interview Survey (NHIS),
                         CDC, NCHS.

  **State Data Sources** National Vital Statistics System (NVSS), CDC,
                         NCHS; Behavioral Risk Factor Surveillance System
                         (BRFSS), CDC, NCCDPHP.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population (age adjusted---see
                         Comments).

  **Baseline**           343 (1997).

  **Numerator**          Number of deaths due to cardiovascular disease
                         as an underlying cause (ICD-9 codes 390-448),
                         among persons who had diabetes listed (ICD-9
                         code 250) as a multiple cause of death.

  **Denominator**        Number of persons who report that they have ever
                         been diagnosed with diabetes.

  **Population           U.S. resident population; U.S. civilian,
  Targeted**             noninstitutionalized population.

  **Questions Used To    For denominator, see Questions Used To Obtain
  Obtain the National    the National Data provided with objective 5-3.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 5-6 for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  5-8. (Developmental)   
  Decrease the           
  proportion of pregnant 
  women with gestational 
  diabetes.              

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Vital Statistics System (NVSS), CDC, NCHS.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  5-9. (Developmental)   
  Reduce the frequency   
  of foot ulcers in      
  persons with diabetes. 

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health and Nutrition Examination Survey
                         (NHANES), CDC, NCHS.

                         Beginning in 1999, NHANES collects information
                         that can be used as a proxy for foot ulcers. The
                         proxy measure that is proposed will track
                         peripheral neuropathy as well as brachial ankle
                         blood pressure index, which indicates peripheral
                         vascular disease.

                         See Part C for a description of NHANES and BRFSS
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  5-10. Reduce the rate  
  of lower extremity     
  amputations in persons 
  with diabetes.         

  **National Data        National Hospital Discharge Survey (NHDS), CDC,
  Sources**              NCHS; National Health Interview Survey (NHIS),
                         CDC, NCHS.

  **State Data Sources** State hospital discharge data systems;
                         Behavioral Risk Factor Surveillance System
                         (BRFSS), CDC, NCCDPHP.

  **Healthy People 2000  Adapted from 17.10 (Diabetes and Chronic
  Objective**            Disabling Conditions).

  **Measure**            Rate per 1,000 population (age adjusted---see
                         Comments).

  **Baseline**           4.1 (1997).

  **Numerator**          Number of hospital discharges among U.S.
                         civilian persons with diabetes (ICD-9-CM code
                         250) as any listed diagnosis and amputation of
                         the lower limb (ICD-9-CM procedure code 84.1) as
                         any listed procedure.

  **Denominator**        Number of persons in the NHIS population who
                         report that they have ever been diagnosed with
                         diabetes.

  **Population           U.S. civilian population; U.S. civilian,
  Targeted**             noninstitutionalized population.

  **Questions Used To    For denominator, see Questions Used To Obtain
  Obtain the National    the National Data provided with objective 5-3.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The numerator and denominator of this measure
                         refer to slightly different populations. The
                         numerator includes the U.S. civilian population;
                         the denominator includes only the U.S. civilian,
                         noninstitutionalized population.

                         The numerator is obtained from the National
                         Hospital Discharge System (NHDS) and uses any
                         mention ICD-9-CM procedure code 84.1 to define
                         amputation of the lower limb and ICD-9-CM code
                         250 as any listed diagnosis to identify persons
                         with diabetes.**^3^** Amputations due to trauma
                         are not included.

                         Adults are considered to have diabetes if they
                         respond "yes" to either of the two questions
                         listed in the denominator section of objective
                         5-3. Those who respond "borderline" are not
                         included. Women who report that the only time
                         they have been diagnosed with diabetes was
                         during pregnancy (gestational diabetes) are also
                         excluded.

                         Children are considered to have diabetes if the
                         adult proxy respondent reports that they have
                         ever been told by a doctor that the child has
                         diabetes. For specific questions, see Questions
                         Used To Obtain the National Data for objective
                         5-3.

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         This objective is a modification of Healthy
                         People 2000 objectives 17.10 and 17.10c, which
                         tracked the proportion of persons with diabetes
                         who had a hospital discharge with an amputation
                         of the lower limb (excluding amputations due to
                         trauma), using ICD-9-CM procedure codes 84.11
                         and 84.12. This measure expands the definition
                         of the amputation of the lower limb to ICD-9-CM
                         procedure code 84.1 and is age adjusted to the
                         2000 standard population.

                         See Part C for a description of NHDS, NHIS, and
                         BRFSS and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  5-11. (Developmental)  
  Increase the           
  proportion of adults   
  with diabetes who      
  obtain an annual       
  urinary microalbumin   
  measurement.           

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the
                         Behavioral Risk Factor Surveillance System
                         (BRFSS), CDC, NCHS.

                         See Part C for a description of BRFSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 5-12. Increase the  |                                                |
| proportion of       |                                                |
| adults with         |                                                |
| diabetes who have a |                                                |
| glycosylated        |                                                |
| hemoglobin          |                                                |
| measurement at      |                                                |
| least once a year.  |                                                |
+=====================+================================================+
| **National Data     | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 24 (1998) (Selected States---see Comments).    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons aged 18 years and older who  |
|                     | report they have ever been diagnosed with      |
|                     | diabetes and report that a doctor, nurse, or   |
|                     | other health professional has checked the      |
|                     | respondent's glycosylated hemoglobin (HbA~1c~) |
|                     | one or more times in the past year.            |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 18 years and older who  |
|                     | report they have ever been diagnosed with      |
|                     | diabetes.                                      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized population |
| Targeted**          | (selected States, see Comments).               |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Behavioral Risk Factor           |
| Obtain the National | Surveillance System:                           |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   About how many times in the last year has  |
|                     |     a doctor, nurse, or other health           |
|                     |     professional checked you for glycosylated  |
|                     |     hemoglobin "A one C"?                      |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     health professional that you have diabetes |
|                     |     or sugar diabetes?                         |
|                     |                                                |
|                     |     \[For females, if yes:\]                   |
|                     |                                                |
|                     |     -   Was this only when you were pregnant?  |
|                     |                                                |
|                     | -   About how many times in the last year have |
|                     |     you seen a doctor, nurse, or other health  |
|                     |     professional for your diabetes?            |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered to have diabetes if     |
|                     | they have ever been told by a doctor or health |
|                     | professional that they have diabetes or sugar  |
|                     | diabetes. Women who report that the only time  |
|                     | they have been diagnosed with diabetes was     |
|                     | during pregnancy (gestational diabetes) are    |
|                     | excluded. Persons are considered to have been  |
|                     | measured for glycosylated hemoglobin if they   |
|                     | have seen a health professional for their      |
|                     | diabetes in the past year at least once and    |
|                     | have been checked for HbA~1c~ one or more      |
|                     | times in the past year.                        |
+---------------------+------------------------------------------------+
|                     | Data for this objective are collected using    |
|                     | the core component and an optional module of   |
|                     | the BRFSS, which is made available to States   |
|                     | for administration annually. The number of     |
|                     | States that select the diabetes module varies  |
|                     | every year. In 1998, 39 States used the        |
|                     | optional diabetes module. The measure is the   |
|                     | mean of data for the reporting States.         |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of BRFSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 5-13. Increase the  |                                                |
| proportion of       |                                                |
| adults with         |                                                |
| diabetes who have   |                                                |
| an annual dilated   |                                                |
| eye examination.    |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 17.23 (Diabetes and Chronic Disabling          |
| 2000 Objective**    | Conditions), age adjusted to the 2000 standard |
|                     | population.                                    |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 47 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons aged 18 years and older who  |
|                     | report that they have ever been told by a      |
|                     | doctor that they have diabetes and report that |
|                     | they had a dilated eye examination in the past |
|                     | year.                                          |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 18 years and older who  |
|                     | report that they have ever been told by a      |
|                     | doctor that they have diabetes.                |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   Have you EVER had an eye examination in    |
|                     |     which the pupils were dilated? This would  |
|                     |     have made you temporarily sensitive to     |
|                     |     bright light.                              |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   When was the last time you had this        |
|                     |     examination?                               |
|                     |                                                |
|                     |     \(1\) A year ago or less\                  |
|                     |     (2) More than 1 year but less than 2       |
|                     |     years\                                     |
|                     |     (3) More than 2 years but less than 3      |
|                     |     years\                                     |
|                     |     (4) More than 3 years but less than 5      |
|                     |     years\                                     |
|                     |     (5) Over 5 years ago                       |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | \[For females:\]                               |
|                     |                                                |
|                     | -   Other than during pregnancy, have you EVER |
|                     |     been told by a doctor or health            |
|                     |     professional that you have diabetes or     |
|                     |     sugar diabetes?                            |
+---------------------+------------------------------------------------+
|                     | \[For males:\]                                 |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     health professional that you have diabetes |
|                     |     or sugar diabetes?                         |
|                     |                                                |
|                     |     Yes\                                       |
|                     |     No\                                        |
|                     |     Borderline\                                |
|                     |     Don't know\                                |
|                     |     Refused                                    |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The numerator is limited to only the persons   |
|                     | who reported that they have seen a health      |
|                     | professional for an eye examination "a year    |
|                     | ago or less."                                  |
+---------------------+------------------------------------------------+
|                     | Persons are considered to have diabetes if     |
|                     | they respond "yes" to either of the two        |
|                     | questions listed above in the denominator      |
|                     | section. Those who respond "borderline" are    |
|                     | not included. Women who report that the only   |
|                     | time they have been diagnosed with diabetes    |
|                     | was during pregnancy (gestational diabetes)    |
|                     | are also excluded.                             |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | State-level data are available from the BRFSS, |
|                     | which uses a slightly different question than  |
|                     | the NHIS to determine the last time the        |
|                     | respondent obtained a dilated eye examination. |
|                     | The question from the 1998 Behavioral Risk     |
|                     | Factor Surveillance System follows:            |
+---------------------+------------------------------------------------+
|                     | -   When was the last time you had an eye      |
|                     |     examination in which the pupils were       |
|                     |     dilated? This would have made you          |
|                     |     temporarily sensitive to bright light.     |
|                     |                                                |
|                     |     1\) Within the past month (0 to 1 month    |
|                     |     ago)\                                      |
|                     |     2) Within the past year (1 to 12 months    |
|                     |     ago)\                                      |
|                     |     3) Within the past 2 years (1 to 2 years   |
|                     |     ago)\                                      |
|                     |     4) 2 or more years ago                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | BRFSS, and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 5-14. Increase the  |                                                |
| proportion of       |                                                |
| adults with         |                                                |
| diabetes who have   |                                                |
| at least an annual  |                                                |
| foot examination.   |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 55 (1998) (selected States---see Comments).    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 18 years and older with  |
|                     | diabetes who report that they have seen a      |
|                     | health professional for diabetes and have had  |
|                     | their feet checked for any sores or            |
|                     | irritations.                                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 years and older who   |
|                     | report that they have ever been told that they |
|                     | have diabetes.                                 |
+---------------------+------------------------------------------------+
| **Population        | Civilian, noninstitutionalized population      |
| Targeted**          | (selected States---see Comments).              |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Behavioral Risk Factor           |
| Obtain the National | Surveillance System:                           |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   About how many times in the last year has  |
|                     |     a health professional checked your feet    |
|                     |     for any sores or irritations?              |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     health professional that you have diabetes |
|                     |     or sugar diabetes?                         |
|                     |                                                |
|                     |     \[For females, if yes:\]                   |
|                     |                                                |
|                     |     -   Was this only when you were pregnant?  |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered to have diabetes if     |
|                     | they had ever been told by a doctor or health  |
|                     | professional that they have diabetes or sugar  |
|                     | diabetes. Women who report that the only time  |
|                     | they have been diagnosed with diabetes was     |
|                     | during pregnancy (gestational diabetes) are    |
|                     | excluded. Persons are considered to have had a |
|                     | foot examination if their feet had been        |
|                     | checked one or more times in the past year.    |
+---------------------+------------------------------------------------+
|                     | Data for this objective are collected using    |
|                     | the core component and an optional module of   |
|                     | the BRFSS, which is made available to States   |
|                     | for administration annually. The number of     |
|                     | States that select the diabetes module varies  |
|                     | every year. In 1998, 39 States used the        |
|                     | optional diabetes module. The measure is the   |
|                     | mean of data for the reporting States.         |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of BRFSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 5-15. Increase the  |                                                |
| proportion of       |                                                |
| persons with        |                                                |
| diabetes who have   |                                                |
| at least an annual  |                                                |
| dental examination. |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 58 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons aged 2 years and older who   |
|                     | report ever being diagnosed with diabetes and  |
|                     | report that they have seen or spoken to a      |
|                     | dentist in the past year.                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 2 years and older who   |
|                     | have ever been told that they have diabetes.   |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   About how long has it been since you last  |
|                     |     saw or talked to a dentist? Include all    |
|                     |     types of dentists, such as orthodontists,  |
|                     |     oral surgeons, and all other dental        |
|                     |     specialists, as well as hygienists.        |
|                     |                                                |
|                     |     \(1\) 6 months or less\                    |
|                     |     (2) More than 6 months but not more than a |
|                     |     year ago\                                  |
|                     |     (3) More than 1 year ago but less than 3   |
|                     |     years ago\                                 |
|                     |     (4) More than 3 years\                     |
|                     |     (5) Never                                  |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]\                              |
|                     | \[For children under 18 years:\]               |
|                     |                                                |
|                     | -   Has a doctor or health professional told   |
|                     |     you that {sample child} has any of these   |
|                     |     conditions?                                |
|                     |                                                |
|                     |     \[List of conditions includes diabetes\]   |
+---------------------+------------------------------------------------+
|                     | \[For adults 18 years and older:\]\            |
|                     | \[For females:\]                               |
|                     |                                                |
|                     | -   Other than during pregnancy, have you EVER |
|                     |     been told by a doctor or health            |
|                     |     professional that you have diabetes or     |
|                     |     sugar diabetes?                            |
+---------------------+------------------------------------------------+
|                     | \[For males:\]                                 |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     health professional that you have diabetes |
|                     |     or sugar diabetes?                         |
|                     |                                                |
|                     |     Yes\                                       |
|                     |     No\                                        |
|                     |     Borderline\                                |
|                     |     Don't know\                                |
|                     |     Refused                                    |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Adults are considered to have diabetes if they |
|                     | respond "yes" to either of the two questions   |
|                     | listed above in the DENOMINATOR section. Those |
|                     | who respond "borderline" are not included.     |
|                     | Women who report that the only time they have  |
|                     | been diagnosed with diabetes was during        |
|                     | pregnancy (gestational diabetes) are also      |
|                     | excluded.                                      |
+---------------------+------------------------------------------------+
|                     | Children are considered to have diabetes if    |
|                     | the adult proxy respondent reports that they   |
|                     | have ever been told by a doctor that the child |
|                     | has diabetes.                                  |
+---------------------+------------------------------------------------+
|                     | An annual dental examination is defined as     |
|                     | seeing or speaking to a dental professional in |
|                     | the past year.                                 |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 5-16. Increase the  |                                                |
| proportion of       |                                                |
| persons with        |                                                |
| diabetes who take   |                                                |
| aspirin at least 15 |                                                |
| times per month.    |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health and Nutrition Examination      |
| Source**            | Survey (NHANES), CDC, NCHS.                    |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 20 (1988--94).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons aged 40 years and older with |
|                     | diabetes who reported taking aspirin products  |
|                     | at least 15 times in the past month.           |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 40 years and older who  |
|                     | report that they have ever been told that they |
|                     | have diabetes.                                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1988--94 National Health and          |
| Obtain the National | Nutrition Examination Survey:                  |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   In the past month, have you taken any      |
|                     |     aspirin, Anacin, Bufferin, Ecotin,         |
|                     |     Ascriptin, or Midol?                       |
+---------------------+------------------------------------------------+
|                     | -   How often did you take aspirin, Anacin,    |
|                     |     Bufferin, Ecotin, Ascriptin, or Midol      |
|                     |     during the past month?                     |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   Have you ever been told by a doctor that   |
|                     |     you have diabetes or sugar diabetes?       |
+---------------------+------------------------------------------------+
|                     | \[For female, if yes:)                         |
|                     |                                                |
|                     | -   Were you pregnant when you were told that  |
|                     |     you had diabetes?                          |
+---------------------+------------------------------------------------+
|                     | -   Other than during pregnancy, has a doctor  |
|                     |     ever told you that you have diabetes or    |
|                     |     sugar diabetes?                            |
+---------------------+------------------------------------------------+
| **Expected          | Annual, beginning with 1999 data.              |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered to have diabetes if     |
|                     | they respond that they have ever been told by  |
|                     | a doctor that they have diabetes or sugar      |
|                     | diabetes. Women who report that the only time  |
|                     | they have been diagnosed with diabetes was     |
|                     | during pregnancy (gestational diabetes) are    |
|                     | excluded.                                      |
+---------------------+------------------------------------------------+
|                     | Persons are considered to have used aspirin    |
|                     | products if they reported using aspirin,       |
|                     | Anacin, Bufferin, Ecotin, Ascriptin, or Midol  |
|                     | 15 or more times in the past month.            |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHANES and     |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ------------------------------- ------------------------------------------------
  5-17. Increase the proportion   
  of adults with diabetes who     
  perform                         
  self-blood-glucose-monitoring   
  at least once daily.            

  **National Data Source**        Behavioral Risk Factor Surveillance System
                                  (BRFSS), CDC, NCCDPHP.

  **State Data Source**           Behavioral Risk Factor Surveillance System
                                  (BRFSS), CDC, NCCDPHP.

  **Healthy People 2000           Not applicable.
  Objective**                     

  **Measure**                     Percent (age adjusted---see Comments).

  **Baseline**                    42 (1998) (selected States---see Comments).

  **Numerator**                   Number of persons aged 18 years and older with
                                  diabetes who report that they check their blood
                                  for glucose or sugar by themselves or by a
                                  family member or friend (excludes health
                                  professional) at least once a day.

  **Denominator**                 Number of persons aged 18 years and older who
                                  report that they have ever been told they have
                                  diabetes.

  **Population Targeted**         Civilian, noninstitutionalized population
                                  (selected States, see Comments).

  **Questions Used To Obtain the  From the 1998 Behavioral Risk Factor
  National Data**                 Surveillance System:
  ------------------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   About how often do you check your blood    |
|                     |     for glucose or sugar? Include times when   |
|                     |     checked by a family member or friend, but  |
|                     |     do not include times when checked by a     |
|                     |     health professional.                       |
|                     |                                                |
|                     |     \_\_\_\_Times per day\                     |
|                     |     \_\_\_\_Times per week\                    |
|                     |     \_\_\_\_Times per month\                   |
|                     |     \_\_\_\_Times per year                     |
+=====================+================================================+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     health professional that you have diabetes |
|                     |     or sugar diabetes?                         |
|                     |                                                |
|                     |     \[For females, if yes:\]                   |
|                     |                                                |
|                     |     -   Was this only when you were pregnant?  |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered to have diabetes if     |
|                     | they have ever been told by a doctor or health |
|                     | professional that they have diabetes or sugar  |
|                     | diabetes. Women who report that the only time  |
|                     | they have been diagnosed with diabetes was     |
|                     | during pregnancy (gestational diabetes) are    |
|                     | excluded. Persons are considered to have had a |
|                     | foot examination if their feet have been       |
|                     | checked one or more times in the past year.    |
+---------------------+------------------------------------------------+
|                     | Data for this objective are collected using    |
|                     | the core component and an optional module of   |
|                     | the BRFSS, which is made available to States   |
|                     | for administration annually. The number of     |
|                     | States that select the diabetes module varies  |
|                     | every year. In 1998, 39 States used the        |
|                     | optional diabetes module. The measure is the   |
|                     | mean of data for the reporting States.         |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of BRFSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

## References

1\. Harris, M.I.; Flegal, K.M.; Cowie, C.C.; et al. Prevalence of
diabetes, impaired fasting glucose, and impaired glucose tolerance in
U.S. adults: The Third National Health and Nutrition Examination Survey,
1988--1994. *Diabetes Care* 21(4): 518-24, 1998.

2\. National Center for Health Statistics. *Healthy People 2000 Review,
1998--99.* Hyattsville, MD: Public Health Service, 1999.

3\. Centers for Disease Control and Prevention. *Diabetes Surveillance
1997.* Atlanta, GA: U.S. Department of Health and Human Services, 1997.