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Diabetes Data Details

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  • D-1 Reduce the annual number of new cases of diagnosed diabetes in the population

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health Interview Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    per 1,000 (age adjusted—see Comments)
    Baseline (Year): 
    8.0 (2006–08)
    Target: 
    7.2
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 to 84 years who report being diagnosed with diabetes in the past 12 months

    Denominator: 

    Number of persons aged 18 to 84 years

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2006-2008 National Health Interview Survey:

      [NUMERATOR:]

      [For females:]

      Other than during pregnancy, have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

      1. Yes
      2. No
      3. Borderline
      4. Don’t know/Not stated
      5. Refused

      [For males:]

      Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

      1. Yes
      2. No
      3. Borderline
      4. Don’t know/Not stated
      5. Refused

      [For males and females:]

      How old were you when a doctor first told you that you had diabetes or sugar diabetes?

      1. _____ years 01-84
      2. 85+ years
      3. Refused
      4. Don't know
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Adults are considered to have diabetes if they respond “yes” to being told by a doctor or health professional that they have diabetes. 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.

      Diagnosed with diabetes in the past 12 months is determined by taking the difference of the reported age at diagnosis from the respondents reported age. All records with a difference of zero (same age) are included and half of the records with a difference value of one are included (to approximate the one year interval as the true time could be greater than one year depending on the birthday and the date of the interview.)

      The measure uses a 3-year moving average to reliably report data for select population groups that have small sample sizes.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-54, 55-64, 65-74, 75-84
      • Sex: 18-44, 45-54, 55-64, 65-74, 75-84
      • Race/Ethnicity: 18-44, 45-54, 55-64, 65-74, 75-84
      • Educational Attainment: 25-44, 45-54, 55-64, 65-74, 75-84
      • Family Income (percent poverty threshold): 18-44, 45-54, 55-64, 65-74, 75-84
      • Family Type: 18-44, 45-54, 55-64, 65-74, 75-84
      • Country of Birth: 18-44, 45-54, 55-64, 65-74, 75-84
      • Disability Status: 18-44, 45-54, 55-64, 65-74, 75-84
      • Geographic Location: 18-44, 45-54, 55-64, 65-74, 75-84
      • Health Insurance Status: 18-44, 45-54, 55-64
      • Marital Status: 18-44, 45-54, 55-64, 65-74, 75-84
      • Sexual Orientation: 18-44, 45-54, 55-64, 65-74, 75-84
    Trend Issues: 
    Beginning with 2018, the American Community Survey questions are no longer available in the NHIS. As a result, tabulated data by disability are discontinued after 2017.
  • D-2 (Developmental) Reduce the death rate among persons with diabetes

    • D-2.1 (Developmental) Reduce the rate of all-cause mortality among persons with diabetes

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Death Index
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 1000 person years (age adjusted—see Comments)
      Numerator: 

      Number of deaths among persons aged 18 years and older with self-reported diabetes among those in the National Health Interview Survey with up to 6 years of follow-up using the NDI.

      Denominator: 

      Total number of person-years accrued by persons age 18 years and older with self-reported diabetes among those in the National Health Interview Survey with up to 6 years of follow-up using the NDI

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the National Health Interview Survey:

        [NUMERATOR:]

        Other than during pregnancy, have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?/Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?]

        1. Yes
        2. No
        3. Borderline
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        4-year NHIS cohorts are followed for up to 6 years of follow up. For example, baseline data from NHIS will include participants from baseline years 2001 through 2004 and mortality follow-up using the NDI through December 31, 2006. Midpoint analyses will use NHIS cohorts from years 2006-2009 with mortality follow-up through 2011. End point analyses (i.e., 2020) will use NHIS cohorts from years 2011-2014 and follow-up through 2016. Modifications may be possible if NHIS-NDI mortality data release achieves an earlier schedule.

        Persons are considered to have doctor diagnosed diabetes if they answer ‘yes’ to the question listed. Diabetes during pregnancy is excluded. Persons who report ‘borderline’ are also excluded.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Disability Status: 18-44, 45-64, 65-74, 75+
        • Educational Attainment: 25-44, 45-64, 65-74, 75+
        • Race/Ethnicity: 18-44, 45-64, 65-74, 75+
        • Family Income (percent poverty threshold): 18-44, 45-64, 65-74, 75+
        • Sex: 18-44, 45-64, 65-74, 75+
        • Health Insurance Status: 18-44, 45-64
        • Family Type: 18-44, 45-64, 65-74, 75+
        • Marital Status: 18-44, 45-64, 65-74, 75+
        • Total: 18-44, 45-64, 65-74, 75+
      Trend Issues: 
      This objective is modified from Healthy People 2010 measure 5-6: Reduce diabetes-related deaths among persons with diabetes. The Healthy People 2010 objective was different from the current objective in HP2020. It measured the rate of diabetes related deaths per 1000 population with diabetes. The numerator included all deaths due to diabetes which included any mentions of diabetes on the death certificate, whether as an underlying or a multiple cause of death in NVSS. The denominator included all persons with self-reported diabetes as reported in the NHIS.
    • D-2.2 (Developmental) Reduce the rate of cardiovascular disease deaths in persons with diagnosed diabetes

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Death Index
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 1000 person years (age adjusted—see Comments)
      Numerator: 

      Number of CVD deaths (ICD 10 I00-I78) among persons age 18 years and older with self-reported diabetes among those in the National Health Interview Survey with up to 6 years of follow-up using the NDI.

      Denominator: 

      Total number of person-years accrued by persons age 18 years and older with self-reported diabetes among those in the National Health Interview Survey with up to 6 years of follow-up using the NDI

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the National Health Interview Survey:

        [NUMERATOR:]

        Other than during pregnancy, have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?/Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?]

        1. Yes
        2. No
        3. Borderline
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        4-year NHIS cohorts are followed for up to 6 years of follow up. For example, baseline data from NHIS will include participants from baseline years 2001 through 2004 and mortality follow-up using the NDI through December 31, 2006. Midpoint analyses will use NHIS cohort years 2006-2009 with mortality follow-up through 2011. End point analyses (i.e., 2020) will use NHIS cohort years of 2011-2014 and follow-up through 2016. Modifications may be possible if NHIS-NDI mortality data release achieves an earlier schedule.

        CVD-related death to be defined using ICD-10 codes I00-I78.
        Persons are considered to have doctor diagnosed diabetes if they answer ‘yes’ to the question listed. Diabetes during pregnancy is excluded. Persons who report ‘borderline’ are also excluded.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Disability Status: 18-44, 45-64, 65-74, 75+
        • Educational Attainment: 25-44, 45-64, 65-74, 75+
        • Race/Ethnicity: 18-44, 45-64, 65-74, 75+
        • Family Income (percent poverty threshold): 18-44, 45-64, 65-74, 75+
        • Sex: 18-44, 45-64, 65-74, 75+
        • Health Insurance Status: 18-44, 45-64
        • Family Type: 18-44, 45-64, 65-74, 75+
        • Marital Status: 18-44, 45-64, 65-74, 75+
        • Total: 18-44, 45-64, 65-74, 75+
      Trend Issues: 
      This objective was modified from HP2010 objective 5-7. The HP2010 objective 5-7 ( reduce deaths from cardiovascular disease in persons with diabetes) was measured differently . In HP2010 the numerator was measured as the number of deaths due to cardiovascular disease as an underlying cause (ICD-10 codes 100-178),among persons who had diabetes listed (ICD-10 code E10 – E14) as a multiple cause of death in NVSS. And the denominator was measured as the number of persons who report that they have ever been diagnosed with diabetes in the NHIS.
  • D-3 Reduce the diabetes death rate

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Bridged-race Population Estimates
    National Vital Statistics System-Mortality
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 100,000 (age adjusted—see Comments)
    Baseline (Year): 
    74.0 (2007)
    Target: 
    66.6
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of deaths due to diabetes (ICD-10 codes E10 - E14) reported as the underlying or multiple cause of death

    Denominator: 

    Number of persons

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      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.

      FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Sex: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Race/Ethnicity: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Country of Birth: <5, 5-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75+
      • Geographic Location: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Marital Status: 25-34, 35-44, 45-54, 55-64, 65-74, 75+
    Trend Issues: 
    Mortality data by marital status were not available for 60% of Georgia’s records in 2008 and 94% of Georgia’s records in 2009. Therefore, 2008 and 2009 data by marital status should be interpreted with caution.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    Bridged-race Population Estimates
    National Vital Statistics System-Mortality
    Measure: 
    per 100,000 (age adjusted—see Comments) (age adjusted—see Comments)
    Numerator: 

    Number of deaths due to diabetes (ICD-10 codes E10 - E14) reported as the underlying or multiple cause of death

    Denominator: 

    Number of persons

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        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.

        FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Sex: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Race/Ethnicity: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Country of Birth: <5, 5-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75+
      • Geographic Location: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Marital Status: 25-34, 35-44, 45-54, 55-64, 65-74, 75+
    Trend Issues: 
    Mortality data by marital status were not available for 60% of Georgia’s records in 2008 and 94% of Georgia’s records in 2009. Therefore, 2008 and 2009 data by marital status should be interpreted with caution.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, rates for 2007–2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator to provide more accurate rates for the period. Thus, the original baseline was revised from 73.1 to 74.0. The target was adjusted from 65.8 to 66.6 to reflect the revised baseline using the original target-setting method. Note that all mortality rates shown here for 2001–2009 (or any subset of those years) are based on intercensal population estimates and may differ from those previously published on the Internet or in print. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.
  • D-4 Reduce the rate of lower extremity amputations in persons with diagnosed diabetes

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health Interview Survey
    National Hospital Discharge Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    per 1,000 (age adjusted—see Comments)
    Baseline (Year): 
    3.5 (2005–07)
    Target: 
    Not applicable
    Target-Setting Method: 
    This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
    Target-Setting Method Justification: 
    Data from 2005–07 show that the rate is 3.5 lower extremity amputations per 1,000 persons with diagnosed diabetes (age adjusted to the year 2000 standard population). Because of this extremely low number, no target seems reasonable. As the rate approaches zero, the decreases observed would become smaller with each percent reduction. Within a short period of time, the rate would reach a value so near zero that further reductions would be too small to be detectable.
    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

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2005-2007 National Health Interview Survey

      [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?

      1. Yes
      2. No
      3. Borderline
      4. Don’t know/Not stated
      5. Refused

      [For males:]

      Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

      1. Yes
      2. No
      3. Borderline
      4. Don’t know/Not stated
      5. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The numerator for this measure 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. Amputations due to trauma are not included.

      Adults are considered to have diabetes if they respond “yes” to either of the two Denominator questions. 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.

      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.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 0-64, 65-74, 75+
      • Sex: 0-64, 65-74, 75+
      • Race/Ethnicity: 0-64, 65-74, 75+
      • Health Insurance Status: 0-44, 45-64
    Caveats and Limitations: 
    Data by race and ethnicity may be underreported in the NHDS.
  • D-5 Improve glycemic control among persons with diabetes

    • D-5.1 Reduce the proportion of persons with diabetes with an A1c value greater than 9 percent
      LHI

      Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      18.0 (2005–08)
      Target: 
      16.2
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 18 years and over with doctor diagnosed diabetes and with HbA1c values >9%

      Denominator: 

      Number of persons aged 18 years and over who report that they have ever been diagnosed with diabetes

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR AND DENOMINATOR:]

        {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or other health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

        1. Yes
        2. No
        3. Borderline
        4. Refused
        5. Don't know
      Data Collection Frequency: 
      Periodic
      Leading Health Indicator:
      Methodology Notes: 

        Persons are considered to have diagnosed diabetes if they respond ‘yes’ to ever being told by a doctor or health professional that they have diabetes or sugar diabetes. Those who respond borderline are counted as ‘no’. Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are excluded. Women who are pregnant at the time of the exam are also excluded.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        For four-year data estimates:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

        For two-year data estimates:

        • Total: 18-39, 40-59, 60+
        • Sex: 18-39, 40-59, 60+
        • Race/Ethnicity: 18-39, 40-59, 60+
        • Educational Attainment: 25-39, 40-59, 60+
        • Family Income (percent poverty threshold): 18-39, 40-59, 60+
        • Country of Birth: 18-39, 40-59, 60+
        • Disability Status: 20-39, 40-59, 60+
        • Health Insurance Status: 18-39, 40-59, 60-64
        • Marital Status: 20-39, 40-59, 60+
        • Veteran Status: 18-39, 40-59, 60+
        • Obesity Status: 20-39, 40-59, 60+
      Caveats and Limitations: 
      The definitions of poor glycemic control can vary for individuals based on factors such as age, co-morbidities, symptomatic history, or social circumstances.
      Trend Issues: 
      Hemoglobin A1c results for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were temporarily withdrawn in November 2011 to evaluate a shift to the right (increased values) in the distribution of Hemoglobin A1c in 2007-2010 compared to 1999-2006. After careful evaluation of participant data, laboratory quality control data and non-NHANES A1c studies, a cause for this shift in the distribution of Hemoglobin A1c could not be identified. Therefore, the Hemoglobin A1c data for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were re-released in March 2012 without changes to the data. The user will need to carefully consider the information presented in this analytic note when analyzing Hemoglobin A1c data from 1999-2010.

      Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Different age adjustment groups are used for the two year and four year data. Two-year estimates are generally less stable and reliable than four-year estimates.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the original baseline was revised from 16.2% to 17.9% due to a change in programming. A cross over regression adjustment was used for the original baseline and has since been removed following the NHANES guidance for these data. The target was adjusted from 14.6% to 16.1% to reflect the revised baseline using the original target-setting method. In 2015, the programming was revised to more explicitly exclude pregnant women from the analysis. The baseline was revised from 17.9% to 18.0%. The target was adjusted from 16.1% to 16.2% following the original target-setting method.
    • D-5.2 Proportion of the diabetic population with an A1c value less than 7 percent

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      53.1 (2005–08)
      Target: 
      Not applicable
      Target-Setting Method: 
      This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
      Target-Setting Method Justification: 
      Given the evolution of practice standards, it is not advisable to perpetuate D- 5.2 as an objective associated with a “target” value. The optimal target proportion with A1c <7% cannot be determined at this time. In the absence of a target-setting method that can acknowledge the impact of an aging diabetic population, Healthy People 2020 should modify objective D-5.2 so that it no longer designates an increasing target level for the general population of persons with diabetes. HP 2020 should continue, however, to track the proportion of diabetic patients whose A1c is less than 7%. We consider this an “informational” function which will help evaluate national trends in the balance between control of hyperglycemia and the possible over-treatment that can contribute to hypoglycemia.
      Numerator: 

      Number of persons aged 18 years and over with doctor diagnosed diabetes and with HbA1c values <7%

      Denominator: 

      Number of persons aged 18 years and over who report that they have ever been diagnosed with diabetes

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR AND DENOMINATOR:]

        {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or other health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

        1. Yes
        2. No
        3. Borderline
        4. Refused
        5. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Persons are considered to have diagnosed diabetes if they respond ‘yes’ to ever being told by a doctor or health professional that they have diabetes or sugar diabetes. Those who respond borderline are counted as ‘no’. Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are excluded. Women who are pregnant at the time of the exam are also excluded.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
      Caveats and Limitations: 
      The definitions of good glycemic control can vary for individuals based on factors such as age, co-morbidities, symptomatic history, or social circumstances.
      Trend Issues: 
      Hemoglobin A1c results for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were temporarily withdrawn in November 2011 to evaluate a shift to the right (increased values) in the distribution of Hemoglobin A1c in 2007-2010 compared to 1999-2006. After careful evaluation of participant data, laboratory quality control data and non-NHANES A1c studies, a cause for this shift in the distribution of Hemoglobin A1c could not be identified. Therefore, the Hemoglobin A1c data for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were re-released in March 2012 without changes to the data. The user will need to carefully consider the information presented in this analytic note when analyzing Hemoglobin A1c data from 1999-2010.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015 this objective was revised from measurable with a target to informational status. Also, in 2015, the programming was revised to more explicitly exclude pregnant women from the analysis. The baseline was revised from 53.5% to 53.1%.
  • D-6 Improve lipid control among persons with diagnosed diabetes

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    53.0 (2005–08)
    Target: 
    58.3
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over with doctor diagnosed diabetes and with LDL cholesterol value <100 mg/dl

    Denominator: 

    Number of persons aged 18 years and over who report that they have ever been diagnosed with diabetes

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2005-2008 National Health and Nutrition Examination Survey:

      [NUMERATOR AND DENOMINATOR:]

      {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or other health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

      1. Yes
      2. No
      3. Borderline
      4. Refused
      5. Don't Know
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      LDL cholesterol data from NHANES are calculated from measured values of total cholesterol, triglycerides, and HDL cholesterol using the Friedewald calculation. This calculation is valid for triglycerides less than or equal to 400mg/dl.

      Persons are considered to have diagnosed diabetes if they respond ‘yes’ to ever being told by a doctor or health professional that they have diabetes or sugar diabetes. Those who respond borderline are counted as ‘no’. Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are also excluded.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-49, 50-59, 60-69, 70-79, 80+
      • Sex: 18-49, 50-59, 60-69, 70-79, 80+
      • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
      • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
      • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
      • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
      • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Health Insurance Status: 18-49, 50-59, 60-64
      • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
      • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    This measure was developmental at launch and became a measurable objective in November 2011. In 2014 the baseline was revised from 53.1% to 53.0%. This revision is due to a change in programming that now excludes pregnant women from the analyses. The target was adjusted from 58.4% to 58.3% to reflect the revised baseline using the original target-setting method of 10% improvement.
  • D-7 Increase the proportion of persons with diagnosed diabetes whose blood pressure is under control

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    51.8 (2005–08)
    Target: 
    57.0
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over with doctor diagnosed diabetes and with systolic blood pressure<130 and diastolic blood pressure  <80

    Denominator: 

    Number of persons aged 18 years and over who report that they have ever been diagnosed with diabetes

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2005-2008 National Health and Nutrition Examination Survey:

      [NUMERATOR AND DENOMINATOR:]

      {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or other health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

      1. Yes
      2. No
      3. Borderline
      4. Refused
      5. Don't Know
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Persons are considered to have diagnosed diabetes if they respond ‘yes’ to ever being told by a doctor or health professional that they have diabetes or sugar diabetes. Those who respond borderline are counted as ‘no’. Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are also excluded.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-49, 50-59, 60-69, 70-79, 80+
      • Sex: 18-49, 50-59, 60-69, 70-79, 80+
      • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
      • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
      • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
      • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
      • Health Insurance Status: 18-49, 50-59, 60-64
      • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
      • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
  • D-8 Increase the proportion of persons with diagnosed diabetes who have at least an annual dental examination

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health Interview Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    55.6 (2008)
    Target: 
    61.2
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 2 years and over who report ever being diagnosed with diabetes and report that they have seen a dentist in the past year

    Denominator: 

    Number of persons aged 2 years and over who have ever been told that they have diabetes

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2008 National Health Interview Survey:

      [NUMERATOR:]

      About how long has it been since you/sample child last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.

      1. Never
      2. 6 months or less
      3. More then 6 months, but not more than 1 yr ago
      4. More than 1 yr, but not more than 2 yrs ago
      5. More than 2 yrs, but not more than 5 yrs ago
      6. More than 5 years ago
      7. Refused
      8. Don't know

      [NUMERATOR and 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?

      1. Yes
      2. No
      3. Borderline
      4. Don't know
      5. Refused

      [For males:]

      Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

      1. Yes
      2. No
      3. Borderline
      4. Don't know
      5. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Adults are considered to have diabetes if they respond “yes” to ever being told by a doctor or health professional that they have diabetes or sugar diabetes. Those who respond “borderline” are counted as ‘no’. 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
      a dental professional in the past year.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 2-44, 45-64, 65+
      • Sex: 2-44, 45-64, 65+
      • Race/Ethnicity: 2-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Family Income (percent poverty threshold): 2-44, 45-64, 65+
      • Family Type: 2-44, 45-64, 65+
      • Country of Birth: 2-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 2-44, 45-64, 65+
      • Health Insurance Status: 2-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Sexual Orientation: 18-44, 45-64, 65+
    Trend Issues: 
    Beginning with 2018, the American Community Survey questions are no longer available in the NHIS. As a result, tabulated data by disability are discontinued after 2017.
  • D-9 Increase the proportion of adults with diabetes who have at least an annual foot examination

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Behavioral Risk Factor Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    69.7 (2012)
    Target: 
    76.7
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over 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 persons aged 18 years and over who report that they have ever been told that they have diabetes

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2012 Behavioral Risk Factor Surveillance System:

      [NUMERATOR:]

      About how many times in the past 12 months has a health professional checked your feet for any sores or irritations?

      1. _ _ Number of times [76=76 or more]
      2. None
      3. Don’t know/Not stated
      4. Refused

      [NUMERATOR AND DENOMINATOR:]

      Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant? [If respondent says pre-diabetes or borderline diabetes, use response code 4.]

      1. Yes
      2. Yes, but female told only during pregnancy
      3. No
      4. No, pre-diabetes or borderline diabetes
      5. Don't know/Not stated
      6. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      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 who responded pre-diabetes or borderline are counted also excluded.

      Persons are considered to have had a foot examination if their feet had been checked one or more times in the past 12 months.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Household Income (percent poverty threshold): 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Obesity Status: 18-44, 45-64, 65+
    Caveats and Limitations: 
    The BRFSS is conducted independently by each state and therefore methodologies may vary. Pooled national estimates may not take into account these differences and so may differ from estimates obtained using data sources that use methodologies designed to produce national estimates.
    Trend Issues: 
    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 2012, 33 States used the optional diabetes module excluding: AZ, CA, CO, DC, FL, IL, IN, IA, LA, MD, MA, MO, MT, NH, NY, ND, RI, and WA.
    In 2013, 37 States including DC used the optional diabetes module, excluding: CA, CO, ID, MD, MA, MS, NH, NY, RI, SD, UT, VT, WA, and WY.
    In 2014, 24 States including DC used the optional diabetes module, including: AL, AZ, CO, DE, DC, FL, GA, IN, IA, LA, ME, MS, NJ, NM, NE, ND, OH, SC, SD, TN, TX, VA, WV, and WY.
    In 2015, 38 States including DC used the optional module excluding: AL, AK, ID, ME, MA, MS, MO, ND, OH, OR, SD, and WV.
    In 2017, 39 States including DC used the optional module excluding: AR, CT, HI, ID, IL, ME, MA, MS, OR, SD, TN, and WV.
    The measure is the mean of data for the reporting States.
    Changes Between HP2010 and HP2020: 
    The measure is the same, however the data source has been redesigned and the data are no longer comparable with the data from the HP2010 objective.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    Behavioral Risk Factor Surveillance System
    Measure: 
    percent (age adjusted—see Comments) (age adjusted—see Comments)
    Numerator: 

    Number of persons aged 18 years and over 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 persons aged 18 years and over who report that they have ever been told that they have diabetes

    Questions Used to Obtain the State Data: 

        From the 2012 Behavioral Risk Factor Surveillance System:

        [NUMERATOR:]

        About how many times in the past 12 months has a health professional checked your feet for any sores or irritations?

        1. _ _ Number of times [76=76 or more]
        2. None
        3. Don’t know/Not stated
        4. Refused

        [NUMERATOR AND DENOMINATOR:]

        Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant? [If respondent says pre-diabetes or borderline diabetes, use response code 4.]

        1. Yes
        2. Yes, but female told only during pregnancy
        3. No
        4. No, pre-diabetes or borderline diabetes
        5. Don't know/Not stated
        6. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        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 who responded pre-diabetes or borderline are counted also excluded.

        Persons are considered to have had a foot examination if their feet had been checked one or more times in the past 12 months.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Household Income (percent poverty threshold): 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Obesity Status: 18-44, 45-64, 65+
    Caveats and Limitations: 
    The BRFSS is conducted independently by each state and therefore methodologies may vary. Pooled national estimates may not take into account these differences and so may differ from estimates obtained using data sources that use methodologies designed to produce national estimates.
    Trend Issues: 
    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 2012, 33 States used the optional diabetes module excluding: AZ, CA, CO, DC, FL, IL, IN, IA, LA, MD, MA, MO, MT, NH, NY, ND, RI, and WA.
    In 2013, 37 States including DC used the optional diabetes module, excluding: CA, CO, ID, MD, MA, MS, NH, NY, RI, SD, UT, VT, WA, and WY.
    In 2014, 24 States including DC used the optional diabetes module, including: AL, AZ, CO, DE, DC, FL, GA, IN, IA, LA, ME, MS, NJ, NM, NE, ND, OH, SC, SD, TN, TX, VA, WV, and WY.
    In 2015, 38 States including DC used the optional module excluding: AL, AK, ID, ME, MA, MS, MO, ND, OH, OR, SD, and WV.
    In 2017, 39 States including DC used the optional module excluding: AR, CT, HI, ID, IL, ME, MA, MS, OR, SD, TN, and WV.
    The measure is the mean of data for the reporting States.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    The data source, BRFSS underwent a redesign in 2011. Due to changes in the weighting methodology and sampling frame, data collected in 2011 and later are not comparable with data collected before the redesign. In 2019, the baseline for this objective was revised to use 2012 data since more states used the diabetes module in 2012 than in 2011 and it was more desirable to set a national target using data that includes more states. As a result, the baseline was revised from 68.0% in 2008 to 69.7% in 2012. The target was revised from 74.8% to 76.7% based on the original target setting methodology of 10% improvement. In 2019, the template data lines for the age subpopulations were changed from displaying for (65-74, 75-84, 85+) to (65-74, 75+) because beginning in 2013 detailed age information beyond 80 years was rolled into one variable.
  • D-10 Increase the proportion of adults with diabetes who have an annual dilated eye examination

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health Interview Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    53.4 (2008)
    Target: 
    58.7
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over 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 over who report that they have ever been told by a doctor that they have diabetes

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2008 National Health Interview Survey:

      [NUMERATOR:]

      When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light.

      1. Less than one month
      2. 1-12 months
      3. 13-24 months
      4. More than 2 years
      5. Never
      6. Refused
      7. Don't know/Not stated

      [NUMERATOR AND 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?

      1. Yes
      2. No
      3. Borderline
      4. Don't know
      5. Refused

      [For males:]

      Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

      1. Yes
      2. No
      3. Borderline
      4. Don't know
      5. Refused
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      The numerator is limited to only the persons who reported that they have seen a health professional for an eye examination “less than one month ago” or “1-12 months ago.”

      Persons are considered to have diabetes if they respond “yes” to being told by a doctor or health professional that they have diabetes. 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.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Family Income (percent poverty threshold): 18-44, 45-64, 65+
      • Family Type: 18-44, 45-64, 65+
      • Country of Birth: 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Sexual Orientation: 18-44, 45-64, 65+
  • D-11 Increase the proportion of adults with diabetes who have a glycosylated hemoglobin measurement at least twice a year

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Behavioral Risk Factor Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    66.3 (2012)
    Target: 
    72.9
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over 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 (HbA1c) two or more times in the past year

    Denominator: 

    Number of persons aged 18 years and over who report they have ever been diagnosed with diabetes

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2012 Behavioral Risk Factor Surveillance System:

      [NUMERATOR:]

      A test for "A one C" measures the average level of blood sugar over the past three months. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for "A one C"?

      1. _ _ Number of times [76=76 or more]
      2. None
      3. Never heard of "A one C" test
      4. Don't know/Not stated
      5. Refused

      [NUMERATOR AND DENOMINATOR:]

      Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant?

      1. Yes
      2. Yes, but female told only during pregnancy
      3. No
      4. No, pre-diabetes or borderline diabetes
      5. Don't know/Not stated
      6. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      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 who report that they have pre-diabetes or borderline diabetes are also excluded from the measure.

      Persons are considered to have been measured for glycosylated hemoglobin if they have been checked for HbA1c two or more times in the past 12 months.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Household Income (percent poverty threshold): 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Obesity Status: 18-44, 45-64, 65+
    Caveats and Limitations: 
    Persons who reported that they have never heard of an HbA1c test are counted as not having had the test. It is possible that some of these people have had an HbA1c test and reported that they do not know due to either communication or cognitive difficulties. The BRFSS is conducted independently by each state and therefore methodologies may vary. Pooled national estimates may not take into account these differences and so may differ from estimates obtained using data sources that use methodologies designed to produce national estimates.
    Trend Issues: 
    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 2012, 33 States used the optional diabetes module excluding: AZ, CA, CO, DC, FL, IL, IN, IA, LA, MD, MA, MO, MT, NH, NY, ND, RI, and WA.
    In 2013, 37 States including DC used the optional diabetes module, excluding: CA, CO, ID, MD, MA, MS, NH, NY, RI, SD, UT, VT, WA, and WY.
    In 2014, 24 States including DC used the optional diabetes module, including: AL, AZ, CO, DE, DC, FL, GA, IN, IA, LA, ME, MS, NJ, NM, NE, ND, OH, SC, SD, TN, TX, VA, WV, and WY.
    In 2015, 38 States including DC used the optional module excluding: AL, AK, ID, ME, MA, MS, MO, ND, OH, OR, SD, and WV.
    In 2017, 39 States including DC used the optional module excluding: AR, CT, HI, ID, IL, ME, MA, MS, OR, SD, TN, and WV.
    The measure is the mean of data for the reporting States.
    Changes Between HP2010 and HP2020: 
    The measure is the same, however the data source has been redesigned and the data are no longer comparable with the data from the HP2010 objective.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    Behavioral Risk Factor Surveillance System
    Measure: 
    percent (age adjusted—see Comments) (age adjusted—see Comments)
    Numerator: 

    Number of persons aged 18 years and over 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 (HbA1c) two or more times in the past year

    Denominator: 

    Number of persons aged 18 years and over who report they have ever been diagnosed with diabetes

    Questions Used to Obtain the State Data: 

        From the 2012 Behavioral Risk Factor Surveillance System:

        [NUMERATOR:]

        A test for "A one C" measures the average level of blood sugar over the past three months. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for "A one C"?

        1. _ _ Number of times [76=76 or more]
        2. None
        3. Never heard of "A one C" test
        4. Don't know/Not stated
        5. Refused

        [NUMERATOR AND DENOMINATOR:]

        Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant?

        1. Yes
        2. Yes, but female told only during pregnancy
        3. No
        4. No, pre-diabetes or borderline diabetes
        5. Don't know/Not stated
        6. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        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 who report that they have pre-diabetes or borderline diabetes are also excluded from the measure.

        Persons are considered to have been measured for glycosylated hemoglobin if they have been checked for HbA1c two or more times in the past 12 months.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Household Income (percent poverty threshold): 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Obesity Status: 18-44, 45-64, 65+
    Caveats and Limitations: 
    Persons who reported that they have never heard of an HbA1c test are counted as not having had the test. It is possible that some of these people have had an HbA1c test and reported that they do not know due to either communication or cognitive difficulties. The BRFSS is conducted independently by each state and therefore methodologies may vary. Pooled national estimates may not take into account these differences and so may differ from estimates obtained using data sources that use methodologies designed to produce national estimates.
    Trend Issues: 
    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 2012, 33 States used the optional diabetes module excluding: AZ, CA, CO, DC, FL, IL, IN, IA, LA, MD, MA, MO, MT, NH, NY, ND, RI, and WA.
    In 2013, 37 States including DC used the optional diabetes module, excluding: CA, CO, ID, MD, MA, MS, NH, NY, RI, SD, UT, VT, WA, and WY.
    In 2014, 24 States including DC used the optional diabetes module, including: AL, AZ, CO, DE, DC, FL, GA, IN, IA, LA, ME, MS, NJ, NM, NE, ND, OH, SC, SD, TN, TX, VA, WV, and WY.
    In 2015, 38 States including DC used the optional module excluding: AL, AK, ID, ME, MA, MS, MO, ND, OH, OR, SD, and WV.
    In 2017, 39 States including DC used the optional module excluding: AR, CT, HI, ID, IL, ME, MA, MS, OR, SD, TN, and WV.
    The measure is the mean of data for the reporting States.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    The data source, BRFSS, underwent a redesign in 2011. Due to changes in the weighting methodology and sampling frame, data collected in 2011 and later are not comparable with data collected before the redesign. In 2019, the baseline for this objective was revised to use 2012 data since more states used the diabetes module in 2012 than in 2011 and it was more desirable to set a national target using data that includes more states. As a result, the baseline was revised from 64.6% in 2008 to 66.3% in 2012. The target was revised from 71.1% to 72.9% based on the original target setting methodology of 10% improvement. In 2019, the template data lines for the age subpopulations were changed from displaying for (65-74, 75-84, 85+) to (65-74, 75+) because beginning in 2013 detailed age information beyond 80 years was rolled into one variable.
  • D-12 Increase the proportion of persons with diagnosed diabetes who obtain an annual urinary microalbumin measurement

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    United States Renal Data System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    33.6 (2007)
    Target: 
    37.0
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of Medicare beneficiaries with diabetes who obtain an annual urinary microalbumin measurement

    Denominator: 

    Number of Medicare beneficiaries with diabetes

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Data for previous years are recalculated for each Annual Data Report from the USRDS data, due to data collection procedures and delay of reporting of some information to the USRDS database. Values displayed are revised accordingly.

      Codes used to determine Microalbuminuria testing are taken directly from the Health Plan Employer Data and Information Set (HEDIS) 2002 specification. HEDIS is a set of standardized measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed Health Care plans. They are CPT codes 82042, 82043, and 82044. CPT (current procedure and terminology) is a listing of descriptive terms and identifying codes for reporting medical services and procedures.

      The cohort includes patients enrolled in Medicare before January 1 of each year, alive and remaining in the program through December 31, and who have diabetes diagnosed during the same year. Patients enrolled in an HMO, or with Medicare as secondary payer, or diagnosed with ESRD during the year are excluded. Microalbuminuria testing is tracked in each year. Age is calculated on Dec. 31 of each year.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    Data for previous years are recalculated for each Annual Data Report from the USRDS data, due to data collection procedures and delay of reporting of some information to the USRDS database. Values displayed are revised accordingly. As a result, in 2015 the baseline was revised from 33.6% to 33.3% of Medicare beneficiaries with diabetes obtained an annual urinary microalbumin measurement in 2007. The target was revised from 37.0% to 36.6% using the original target setting method. Then in 2018, the baseline was revised from 33.3% to 33.6% of Medicare beneficiaries with diabetes obtained an annual urinary microalbumin measurement in 2007. The target was revised from 36.6% to 37.0% using the original target setting method.
  • D-13 Increase the proportion of adults with diabetes who perform self-blood glucose-monitoring at least once daily

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Behavioral Risk Factor Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    65.9 (2012)
    Target: 
    72.5
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over 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 over who report that they have ever been told they have diabetes

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2012 Behavioral Risk Factor 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.

      1. ____Times per day
      2. ____Times per week
      3. ____Times per month
      4. ____Times per year

      [NUMERATOR and DENOMINATOR:]

      Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant? [If respondent says pre-diabetes or borderline diabetes, use response code 4.]

      1. Yes
      2. Yes, but female told only during pregnancy
      3. No
      4. No, pre-diabetes or borderline diabetes
      5. Don't know/Not stated
      6. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      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 who reported borderline or prediabetes are also excluded.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Household Income (percent poverty threshold): 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Obesity Status: 18-44, 45-64, 65+
    Caveats and Limitations: 
    The BRFSS is conducted independently by each state and therefore methodologies may vary. Pooled national estimates may not take into account these differences and so may differ from estimates obtained using data sources that use methodologies designed to produce national estimates.
    Trend Issues: 
    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 2012, 33 States used the optional diabetes module excluding: AZ, CA, CO, DC, FL, IL, IN, IA, LA, MD, MA, MO, MT, NH, NY, ND, RI, and WA.
    In 2013, 37 States including DC used the optional diabetes module, excluding: CA, CO, ID, MD, MA, MS, NH, NY, RI, SD, UT, VT, WA, and WY.
    In 2014, 24 States including DC used the optional diabetes module, including: AL, AZ, CO, DE, DC, FL, GA, IN, IA, LA, ME, MS, NJ, NM, NE, ND, OH, SC, SD, TN, TX, VA, WV, and WY.
    In 2015, 38 States including DC used the optional module excluding: AL, AK, ID, ME, MA, MS, MO, ND, OH, OR, SD, and WV.
    In 2017, 39 States including DC used the optional module excluding: AR, CT, HI, ID, IL, ME, MA, MS, OR, SD, TN, and WV.
    The measure is the mean of data for the reporting States.
    Changes Between HP2010 and HP2020: 
    The measure is the same, however the data source has been redesigned and the data are no longer comparable with the data from the HP2010 objective.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    Behavioral Risk Factor Surveillance System
    Measure: 
    percent (age adjusted—see Comments) (age adjusted—see Comments)
    Numerator: 

    Number of persons aged 18 years and over 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 over who report that they have ever been told they have diabetes

    Questions Used to Obtain the State Data: 

        From the 2012 Behavioral Risk Factor 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.

        1. ____Times per day
        2. ____Times per week
        3. ____Times per month
        4. ____Times per year

        [NUMERATOR and DENOMINATOR:]

        Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant? [If respondent says pre-diabetes or borderline diabetes, use response code 4.]

        1. Yes
        2. Yes, but female told only during pregnancy
        3. No
        4. No, pre-diabetes or borderline diabetes
        5. Don't know/Not stated
        6. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        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 who reported borderline or prediabetes are also excluded.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Household Income (percent poverty threshold): 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Obesity Status: 18-44, 45-64, 65+
    Caveats and Limitations: 
    The BRFSS is conducted independently by each state and therefore methodologies may vary. Pooled national estimates may not take into account these differences and so may differ from estimates obtained using data sources that use methodologies designed to produce national estimates.
    Trend Issues: 
    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 2012, 33 States used the optional diabetes module excluding: AZ, CA, CO, DC, FL, IL, IN, IA, LA, MD, MA, MO, MT, NH, NY, ND, RI, and WA.
    In 2013, 37 States including DC used the optional diabetes module, excluding: CA, CO, ID, MD, MA, MS, NH, NY, RI, SD, UT, VT, WA, and WY.
    In 2014, 24 States including DC used the optional diabetes module, including: AL, AZ, CO, DE, DC, FL, GA, IN, IA, LA, ME, MS, NJ, NM, NE, ND, OH, SC, SD, TN, TX, VA, WV, and WY.
    In 2015, 38 States including DC used the optional module excluding: AL, AK, ID, ME, MA, MS, MO, ND, OH, OR, SD, and WV.
    In 2017, 39 States including DC used the optional module excluding: AR, CT, HI, ID, IL, ME, MA, MS, OR, SD, TN, and WV.
    The measure is the mean of data for the reporting States.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    The data source, BRFSS, underwent a redesign in 2011. Due to changes in the weighting methodology and sampling frame, data collected in 2011 and later are not comparable with data collected before the redesign. In 2019, the baseline for this objective was revised to use 2012 data since more states used the diabetes module in 2012 than in 2011 and it was more desirable to set a national target using data that includes more states. As a result, the baseline was revised from 64.0% in 2008 to 65.9% in 2012. The target was revised from 70.4% to 72.5% based on the original target setting methodology of 10% improvement. In 2019, the template data lines for the age subpopulations were changed from displaying for (65-74, 75-84, 85+) to (65-74, 75+) because beginning in 2013 detailed age information beyond 80 years was rolled into one variable.
  • D-14 Increase the proportion of persons with diagnosed diabetes who receive formal diabetes education

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Behavioral Risk Factor Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    53.1 (2012)
    Target: 
    58.4
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over 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 over who report that they have ever been diagnosed with diabetes

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2012 Behavioral Risk Factor Surveillance System:

      [NUMERATOR:]

      Have you ever taken a course or class in how to manage your diabetes yourself?

      1. Yes
      2. No
      3. Don't know / Not sure
      4. Refused

      [NUMERATOR AND DENOMINATOR:]

      Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant? [If respondent says pre-diabetes or borderline diabetes, use response code 4.]

      1. Yes
      2. Yes, but female told only during pregnancy
      3. No
      4. No, pre-diabetes or borderline diabetes
      5. Don't know/Not stated
      6. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Persons are considered to have diabetes if they respond “yes” to the question “have you ever been told by a doctor that you have diabetes”. Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are excluded. Persons who report that they have pre-diabetes or borderline diabetes are also excluded.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Household Income (percent poverty threshold): 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Obesity Status: 18-44, 45-64, 65+
    Caveats and Limitations: 
    The BRFSS is conducted independently by each state and therefore methodologies may vary. Pooled national estimates may not take into account these differences and so may differ from estimates obtained using data sources that use methodologies designed to produce national estimates.
    Trend Issues: 
    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 2012, 33 States used the optional diabetes module excluding: AZ, CA, CO, DC, FL, IL, IN, IA, LA, MD, MA, MO, MT, NH, NY, ND, RI, and WA.
    In 2013, 37 States including DC used the optional diabetes module, excluding: CA, CO, ID, MD, MA, MS, NH, NY, RI, SD, UT, VT, WA, and WY.
    In 2014, 24 States including DC used the optional diabetes module, including: AL, AZ, CO, DE, DC, FL, GA, IN, IA, LA, ME, MS, NJ, NM, NE, ND, OH, SC, SD, TN, TX, VA, WV, and WY.
    In 2015, 38 States including DC used the optional module excluding: AL, AK, ID, ME, MA, MS, MO, ND, OH, OR, SD, and WV.
    In 2017, 39 States including DC used the optional module excluding: AR, CT, HI, ID, IL, ME, MA, MS, OR, SD, TN, and WV.
    The measure is the mean of data for the reporting States.
    Changes Between HP2010 and HP2020: 
    This objective tracks the same measure as Healthy People 2010 objective 5-1. However the data source has changed from the National Health Interview Survey (NHIS) for objective 5.1 to the BRFSS for this objective.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    Behavioral Risk Factor Surveillance System
    Measure: 
    percent (age adjusted—see Comments) (age adjusted—see Comments)
    Numerator: 

    Number of persons aged 18 years and over 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 over who report that they have ever been diagnosed with diabetes

    Questions Used to Obtain the State Data: 

        From the 2012 Behavioral Risk Factor Surveillance System:

        [NUMERATOR:]

        Have you ever taken a course or class in how to manage your diabetes yourself?

        1. Yes
        2. No
        3. Don't know / Not sure
        4. Refused

        [NUMERATOR AND DENOMINATOR:]

        Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant? [If respondent says pre-diabetes or borderline diabetes, use response code 4.]

        1. Yes
        2. Yes, but female told only during pregnancy
        3. No
        4. No, pre-diabetes or borderline diabetes
        5. Don't know/Not stated
        6. Refused
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        Persons are considered to have diabetes if they respond “yes” to the question “have you ever been told by a doctor that you have diabetes”. Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are excluded. Persons who report that they have pre-diabetes or borderline diabetes are also excluded.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Household Income (percent poverty threshold): 18-44, 45-64, 65+
      • Disability Status: 18-44, 45-64, 65+
      • Geographic Location: 18-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 18-44, 45-64, 65+
      • Obesity Status: 18-44, 45-64, 65+
    Caveats and Limitations: 
    The BRFSS is conducted independently by each state and therefore methodologies may vary. Pooled national estimates may not take into account these differences and so may differ from estimates obtained using data sources that use methodologies designed to produce national estimates.
    Trend Issues: 
    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 2012, 33 States used the optional diabetes module excluding: AZ, CA, CO, DC, FL, IL, IN, IA, LA, MD, MA, MO, MT, NH, NY, ND, RI, and WA.
    In 2013, 37 States including DC used the optional diabetes module, excluding: CA, CO, ID, MD, MA, MS, NH, NY, RI, SD, UT, VT, WA, and WY.
    In 2014, 24 States including DC used the optional diabetes module, including: AL, AZ, CO, DE, DC, FL, GA, IN, IA, LA, ME, MS, NJ, NM, NE, ND, OH, SC, SD, TN, TX, VA, WV, and WY.
    In 2015, 38 States including DC used the optional module excluding: AL, AK, ID, ME, MA, MS, MO, ND, OH, OR, SD, and WV.
    In 2017, 39 States including DC used the optional module excluding: AR, CT, HI, ID, IL, ME, MA, MS, OR, SD, TN, and WV.
    The measure is the mean of data for the reporting States.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    The data source, BRFSS, underwent a redesign in 2011. Due to changes in the weighting methodology and sampling frame, data collected in 2011 and later are not comparable with data collected before the redesign. In 2019, the baseline for this objective was revised to use 2012 data since more states used the diabetes module in 2012 than in 2011 and it was more desirable to set a national target using data that includes more states. As a result, the baseline was revised from 56.8% in 2008 to 53.1% in 2012. The target was revised from 62.5% to 58.4% based on the original target setting methodology of 10% improvement. In 2019, The template data lines for the age subpopulations were changed from displaying for (65-74, 75-84, 85+) to (65-74, 75+) because beginning in 2013 detailed age information beyond 80 years was rolled into one variable.
  • D-15 Increase the proportion of persons with diabetes whose condition has been diagnosed

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    72.5 (2005–08)
    Target: 
    79.8
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 20 years and over who report that they have ever been diagnosed with diabetes

    Denominator: 

    Number of persons aged 20 years and over who report that they have ever been diagnosed with diabetes plus the number of persons aged 20 years and over who have undiagnosed diabetes (a fasting blood glucose level greater or equal to 126 mg/dl or an HbA1c level greater or equal to 6.5)

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2005-2008 National Health and Nutrition Examination Survey:

      [NUMERATOR AND DENOMINATOR:]

      {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or other health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

      1. Yes
      2. No
      3. Borderline or pre-diabetes
      4. Refused
      5. Don't know/Not stated
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Persons are considered to have diagnosed diabetes if they respond “yes” to the question “have you ever been told by a doctor that you have diabetes.” Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are excluded. Persons who report that they have pre-diabetes or borderline diabetes are counted as ‘no’. The undiagnosed population with diabetes is based on the American Diabetes Association criteria.

      Data for HbA1c are available for the whole sample, but data for fasting glucose are only measured for the morning examination session. For these analysis the cohort examined is restricted to persons in the AM exam session only.

      Backward calibration equations were used to account for changes in plasma glucose laboratory procedures over time.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 20-49, 50-59, 60-69, 70-79, 80+
      • Sex: 20-49, 50-59, 60-69, 70-79, 80+
      • Race/Ethnicity: 20-49, 50-59, 60-69, 70-79, 80+
      • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
      • Family Income (percent poverty threshold): 20-49, 50-59, 60-69, 70-79, 80+
      • Country of Birth: 20-49, 50-59, 60-69, 70-79, 80+
      • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Health Insurance Status: 20-49, 50-59, 60-64
      • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Veteran Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
    Trend Issues: 
    Hemoglobin A1c results for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were temporarily withdrawn in November 2011 to evaluate a shift to the right (increased values) in the distribution of Hemoglobin A1c in 2007-2010 compared to 1999-2006. After careful evaluation of participant data, laboratory quality control data and non-NHANES A1c studies, a cause for this shift in the distribution of Hemoglobin A1c could not be identified. Therefore, the Hemoglobin A1c data for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were re-released in March 2012 without changes to the data. The user will need to carefully consider the information presented in this analytic note when analyzing Hemoglobin A1c data from 1999-2010.
    Changes Between HP2010 and HP2020: 
    This objective tracks the same measure as Healthy People 2010 objective 5-4, however the American Diabetes Association (ADA) released new diabetes diagnosis criteria in the year 2010. For Healthy People 2010, undiagnosed diabetes was determined using fasting glucose levels. For Healthy People 2020, following the newest guidelines, undiagnosed diabetes is determined using both fasting glucose levels as well as A1c levels.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015 the programming for this objective was revised to more explicitly exclude pregnant women from the analysis and apply the fasting weight to the entire measure (it was previously applied only to the part of the measure that used laboratory data). As a result the baseline was revised from 72.8% to 72.5%, and the target was revised from 80.1% to 79.8% using the original target setting method.
  • D-16 Increase prevention behaviors in persons at high risk for diabetes with prediabetes

    • D-16.1 Increase the proportion of persons at high risk for diabetes with prediabetes who report increasing their levels of physical activity

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      44.6 (2005–08)
      Target: 
      49.1
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number persons aged 18 years and over who are high risk for diabetes and who report increasing their physical activity

      Denominator: 

      Number of persons aged 18 years and over without self-reported diabetes who have a fasting glucose greater than or equal to 100 and less than 126mg/dl or an HbA1c value greater than or equal to 5.7%  and <6.5%.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        To lower {your/his/her} risk for certain diseases, {are you/is s/he} now doing any of the following:

        b. increasing {your/his/her} physical activity or exercise?

        1. Yes
        2. No
        3. Refused
        4. Don't know
        5. Missing

        [NUMERATOR and DENOMINATOR:]

        {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

        1. Yes
        2. No
        3. Borderline
        4. Refused
        5. Don't know
        6. Missing
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The population at high risk for developing diabetes is defined as persons who have pre-diabetes—this includes persons who do not have doctor diagnosed diabetes (do not respond yes to ever being diagnosed with diabetes or sugar diabetes) and have either a fasting blood glucose level of greater than or equal to 100 or less than 126 mg/dl or have an A1c level of ≥5.7% to <6.5%.

        Data for HbA1c are available for the whole sample, but data for fasting glucose are only measured for the morning examination session. For these analysis the cohort examined is restricted to persons in the AM exam session only.

        Backward calibration equations were used to account for changes in plasma glucose laboratory procedures over time.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-29, 30-39, 40-49, 50-59, 60-64
        • Marital Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      Trend Issues: 
      Hemoglobin A1c results for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were temporarily withdrawn in November 2011 to evaluate a shift to the right (increased values) in the distribution of Hemoglobin A1c in 2007-2010 compared to 1999-2006. After careful evaluation of participant data, laboratory quality control data and non-NHANES A1c studies, a cause for this shift in the distribution of Hemoglobin A1c could not be identified. Therefore, the Hemoglobin A1c data for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were re-released in March 2012 without changes to the data. The user will need to carefully consider the information presented in this analytic note when analyzing Hemoglobin A1c data from 1999-2010.

      Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Two-year estimates are generally less stable and reliable than four-year estimates.
    • D-16.2 Increase the proportion of persons at high risk for diabetes with prediabetes who report trying to lose weight

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      50.0 (2005–08)
      Target: 
      55.0
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 18 years and over who are high risk for diabetes and who report trying to lose weight

      Denominator: 

      Number of persons aged 18 years and over without self-reported diabetes who have a fasting glucose greater than or equal to 100 and less than 126mg/dl or an HbA1c value greater than or equal to 5.7%  and <6.5%.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        To lower {your/his/her} risk for certain diseases, {are you/is s/he} now doing any of the following:

        a. controlling {your/his/her} weight or losing weight?

        1. Yes
        2. No
        3. Refused
        4. Don't know
        5. Missing

        [NUMERATOR and DENOMINATOR:]

        {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

        1. Yes
        2. No
        3. Borderline
        4. Refused
        5. Don't know
        6. Missing
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The population at high risk for developing diabetes is defined as persons who have pre-diabetes—this includes persons who have do not have doctor diagnosed diabetes (do not respond yes to ever being diagnosed with diabetes or sugar diabetes) and have either a fasting blood glucose level of greater than or equal to 100 or less than 126 mg/dl or have an A1c level of ≥5.7% to <6.5%.

        Data for HbA1c are available for the whole sample, but data for fasting glucose are only measured for the morning examination session. For these analysis the cohort examined is restricted to persons in the AM exam session only.

        Backward calibration equations were used to account for changes in plasma glucose laboratory procedures over time.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-29, 30-39, 40-49, 50-59, 60-64
        • Marital Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      Trend Issues: 
      Hemoglobin A1c results for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were temporarily withdrawn in November 2011 to evaluate a shift to the right (increased values) in the distribution of Hemoglobin A1c in 2007-2010 compared to 1999-2006. After careful evaluation of participant data, laboratory quality control data and non-NHANES A1c studies, a cause for this shift in the distribution of Hemoglobin A1c could not be identified. Therefore, the Hemoglobin A1c data for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were re-released in March 2012 without changes to the data. The user will need to carefully consider the information presented in this analytic note when analyzing Hemoglobin A1c data from 1999-2010.

      Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Two-year estimates are generally less stable and reliable than four-year estimates.
    • D-16.3 Increase the proportion of persons at high risk for diabetes with prediabetes who report reducing the amount of fat or calories in their diet

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      48.5 (2005–08)
      Target: 
      53.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 18 years and over who are high risk for diabetes and who report reducing the amount of fat or calories in their diet

      Denominator: 

      Number of persons aged 18 years and over without self-reported diabetes who have a fasting glucose greater than or equal to 100 and less than 126mg/dl or an HbA1c value greater than or equal to 5.7%  and <6.5%.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        To lower {your/his/her} risk for certain diseases, {are you/is s/he} now doing any of the following:

        c. reducing the amount of fat or calories in {your/his/her} diet? ____

        1. Yes
        2. No
        3. Refused
        4. Don't know
        5. Missing

        [NUMERATOR and DENOMINATOR:]

        {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

        1. Yes
        2. No
        3. Borderline
        4. Refused
        5. Don't know
        6. Missing
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The population at high risk for developing diabetes is defined as persons who have pre-diabetes—this includes persons who have do not have doctor diagnosed diabetes (do not respond yes to ever being diagnosed with diabetes or sugar diabetes) and have either a fasting blood glucose level of greater than or equal to 100 or less than 126 mg/dl or have an A1c level of ≥5.7% to <6.5%.

        Data for HbA1c are available for the whole sample, but data for fasting glucose are only measured for the morning examination session. For these analysis the cohort examined is restricted to persons in the AM exam session only.

        Backward calibration equations were used to account for changes in plasma glucose laboratory procedures over time.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-29, 30-39, 40-49, 50-59, 60-64
        • Marital Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      Trend Issues: 
      Hemoglobin A1c results for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were temporarily withdrawn in November 2011 to evaluate a shift to the right (increased values) in the distribution of Hemoglobin A1c in 2007-2010 compared to 1999-2006. After careful evaluation of participant data, laboratory quality control data and non-NHANES A1c studies, a cause for this shift in the distribution of Hemoglobin A1c could not be identified. Therefore, the Hemoglobin A1c data for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were re-released in March 2012 without changes to the data. The user will need to carefully consider the information presented in this analytic note when analyzing Hemoglobin A1c data from 1999-2010.

      Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Two-year estimates are generally less stable and reliable than four-year estimates.