Definition of Indicators - Diabetes Profile

Risk Factor for Diabetes

Among adults without diabetes (County Level Study)

Overweight without diabetes

Missouri adults aged 18 years or older who reported NO to having physician-diagnosed diabetes and had a Body Mass Index (BMI) greater than or equal to 25 and less than 30.

BMI is derived from the following BRFSS questions: 

 " About how much do you weigh without shoes? "

 " About how tall are you without shoes?"

Obesity without diabetes

Missouri adults aged 18 years or older who reported NO to having physician-diagnosed diabetes and had a Body Mass Index (BMI) greater than or equal to 30

BMI is derived from the following BRFSS questions: 

"About how much do you weigh without shoes?" 

"About how tall are you without shoes?"

Physical inactivity without diabetes

Missouri adults aged 18 years or older who reported NO to having physician-diagnosed diabetes and reported no leisure-time physical activity or exercise in the last 30 days

Physical inactivity is derived from the following BRFSS question: 

" During the past month, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise?”

Among youth (YTS/YRBSS)

Insufficient physical activity- High School

Insufficient physical activity- Middle School

Students of public middle and high schools in Missouri who reported insufficient physical activity

Insufficient physical activity does not reach the level (at least 60 minutes per day, 7 days per week) that is recommended for children and adolescents in the 2008 Physical Activity Guidelines for Americans.

Insufficient physical activity is derived from the following YTS question: 

"During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?"

(Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time.)

Low fruit and vegetable intake- High School

Low fruit and vegetable intake- Middle School

Students of public middle and high schools in Missouri who reported eating fruits and vegetables less than 5 times per day. Derived by calculating number of times that fruits and vegetables were eaten per day using the following questions:

"During the past 7 days, how many times did you drink 100% fruit juices such as orange juice, apple juice, or grape juice?" (Do not count punch, Kool-Aid, sports drinks, or other fruit-flavored drinks.)

"During the past 7 days, how many times did you eat fruit?" (Do not count fruit juice.)

"During the past 7 days, how many times did you eat green salad?"

"During the past 7 days, how many times did you eat potatoes?" (Do not count french fries, fried potatoes, or potato chips.)

"During the past 7 days, how many times did you eat carrots?"

"During the past 7 days, how many times did you eat other vegetables?" (Do not count green salad, potatoes, or carrots.)

Diabetes prevalence among adults (BRFSS)

All adults >= 18 years of age

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes 

Diabetes prevalence is derived from the following BRFSS question: 

"Have you ever been told by a doctor that you have diabetes?"

Age 18-44

Age 45-54

Age 55-64

Age 65+

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes
Age categories are derived from the following BRFSS question:

"What is your age?"

Annual household income

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes

Less than $15000

$15000-$24999

$25000-$34999

$35000-$49999

$50000+

Income categories are derived from the following BRFSS question: 

"What is your annual household income from all sources?"

Educational attainment

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes

Less than high school

High school or GED

Some post high school

College or tech school graduate

Education categories are derived from the BRFSS question: 

"What is the highest grade or year of school you completed?"

Risk factor complications among adults with diabetes (County Level Study)

Overweight with diabetes

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and had a Body Mass Index (BMI) greater than or equal to 25 and less than 30.

BMI is derived from the following BRFSS questions:

"About how much do you weigh without shoes?"

"About how tall are you without shoes?"

Obesity with diabetes

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and had a Body Mass Index (BMI) greater than or equal to 30

BMI is derived from the following BRFSS questions:

"About how much do you weigh without shoes?"

"About how tall are you without shoes?"

Current smoking with diabetesMissouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and who were identified as current smokers

Smoking status is derived from the following BRFSS questions:

"Have you smoked at least 100 cigarettes in your entire lifetime?"

"Do you now smoke cigarettes every day, some days, or not at all?"

Physical inactivity with diabetes

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported no leisure-time physical activity or exercise in the last 30 days

Physical inactivity is derived from the following BRFSS question:

"During the past month, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise?”

Low fruit and vegetable intake with diabetes

Adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported eating fruits and vegetables less than five times per day. Derived by calculating number of times that fruits and vegetables were eaten per day using the following questions:

"During the past month, how many times per day, week, or month did you drink 100% pure fruit juices?"

"During the past month, not counting juice, how many times per day, week, or month did you eat fruit?" Count fresh, frozen, or canned fruit.

"During the past month, how many times per day, week, or month did you eat cooked or canned beans, such as refried, baked, black, garbanzo beans, beans in soup, soybeans, edamame, tofu, or lentils?".

Do NOT include long green beans.

"During the past month, how many times per day, week, or month did you eat dark green vegetables, for example broccoli or dark leafy greens including romaine, chard, collard greens or spinach?"

"During the past month, how many times per day, week, or month did you eat orange-colored vegetables such as sweet potatoes, pumpkin, winter squash, or carrots?"

"Not counting what you just told me about, during the past month, about how many times per day, week, or month did you eat OTHER vegetables?"

Preventive care practices among adults with diabetes (BRFSS)

Teeth cleaned within past year

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported teeth cleaning in the past year

Teeth cleaned is derived from the following BRFSS question: 

"How long has it been since you had your teeth cleaned by a dentist or dental hygienist?"

Current health coverage

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported no current health coverage

Current health coverage is derived from the following BRFSS question: 

"Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?"

A1C tests within the past year- 0 to 1 tests

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes

A1C tests within the past year- 2 to 3 tests

A1C tests within the past year- 4 or more tests

A1C categories are derived from the following BRFSS question: 

"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 hemoglobin “A one C”?"

Annual foot exam by a health care professional

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported having an annual foot exam

Foot exam categories were derived from the following BRFSS question:

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

Last dilated eye exam- within the last year

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported having a dilated eye exam in the last year

Last dilated eye exam- more than 1 year but less than 2 years

Last dilated eye exam- 2 or more years

Dilated eye exam categories were derived from the following BRFSS question: 

"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."

Daily self checks for blood glucose

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported daily self checks for blood glucose

Daily self checks for blood glucose is derived from the following BRFSS question: 

"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.

Flu shot within the past year

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported obtaining a flu shot within the past year

Flu shot status is derived from the following BRFSS question: 

"During the past 12 months, have you had a flu shot?"

Pneumonia vaccination

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported obtaining a pneumonia vaccination

Pneumonia vaccine status was derived from the following BRFSS question: 

"Have you ever had a pneumonia shot?" This shot is usually given only once or twice in a persons lifetime and is different from the flu shot. It is also called the pneumococcal vaccine.

Self-management education course

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported taking a diabetes self-management education course

Education course status was derived from the following BRFSS question: 

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

Complications of diabetes for adults (BRFSS)

Eye complications and/or diabetic retinopathy

Missouri adults aged 18 years or older who reported YES to having physician-diagnosed diabetes and reported eye complications and/or diabetes retinopathy

Eye complications status is derived from the following BRFSS question: 

"Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?"

Preventive. care practices among adults with diabetes and hypertension (BRFSS)

Currently on high blood pressure medicine

Missouri adults aged 18 years or older who reported YES to having both physician-diagnosed diabetes and physician-diagnosed hypertension

Currently on high blood pressure medicine is derived from the following BRFSS question: 

"Are you currently taking medicine for your high blood pressure?"

Morbidity/PAS (Hospitalization and ER Indicators)

Diabetes in pregnancy

Births to women with insulin-dependent diabetes

resident live birth for which a maternal medical risk factor indicated diabetes (insulin dependent) on the birth certificate. Insulin dependent implies that the mother is dependent on exogenous insulin to prevent ketoacidosis and death. Diabetic ketoacidosis is a state of insulin deficiency.

Births to women with other diabetes

resident live birth for which a maternal medical risk factor indicated diabetes (other diabetes) on the birth certificate. The mother may or may not use insulin for symptom control but does not need it for survival.

Emergency room visits for persons with diabetes

Diabetes as the principal diagnosis

Resident ER visits for which the principal diagnosis given on the Patient Abstract System (PAS) of emergency department records was diabetes or a diabetes-related problem.
International Classification of Diseases (ICD-9-CM) codes 250, 7902, 7915, 7916, V5391, V6546

Total charges

The amount that the hospital charges for emergency room discharges for residents of the area (state, region, county) who were discharged with diabetes as a principal diagnosis. The charges do not necessarily represent the cost to the hospital of providing the care nor do they represent the amount actually collected by the hospital for providing the care.

Diabetes as the principal or a secondary diagnosis

Resident ER visits for which any diagnosis given on the Patient Abstract System (PAS) of emergency department records was diabetes or a diabetes-related problem.

International Classification of Diseases (ICD-9-CM) codes 250, 7902, 7915, 7916, V4585, V5391, V6546

Hospitalizations for persons with diabetes

Diabetes as the principal diagnosis

Resident hospitalizations for which the principal diagnosis given on the Patient Abstract System (PAS) of inpatient records was diabetes or a diabetes-related problem.

International Classification of Diseases (ICD-9-CM) codes 250, 7902, 7915, 7916, V5391, V6546.

Total charges

The amount that the hospital charges for inpatient hospitalization discharges for residents of the area (state, region, county) who were discharged with diabetes as a principal diagnosis. The charges do not necessarily represent the cost to the hospital of providing the care nor do they represent the amount actually collected by the hospital for providing the care.

Days of care

The days of care (length of stay) in the hospital for residents of the area (state, region, county) who were discharged with a diagnosis of diabetes as a principal diagnosis.

Diabetes as the principal or a secondary diagnosis

Resident hospitalizations for which any diagnosis given on the Patient Abstract System (PAS) of inpatient records was diabetes or a diabetes-related problem.

International Classification of Diseases (ICD-9-CM) codes 250, 7902, 7915, 7916, V4585, V5391, V6546

Total charges

The amount that the hospital charges for inpatient hospitalization discharges for residents of the area (state, region, county) who were discharged with diabetes as a principal or secondary diagnosis. The charges do not necessarily represent the cost to the hospital of providing the care nor do they represent the amount actually collected by the hospital for providing the care.

Days of care

The days of care (length of stay) in the hospital for residents of the area (state, region, county) who were discharged with a diagnosis of diabetes as a principal or secondary diagnosis.

Heart disease as the principal diagnosis

Resident hospitalizations for which the principal diagnosis given on the Patient Abstract System (PAS) of inpatient records was heart disease.

International Classification of Diseases (ICD-9-CM) codes from 390 to 398, 404 to 429, and 402), and any secondary diagnosis was diabetes or a diabetes-related problem (ICD-9-CM codes 250, 7902, 7915, 7916, V4585, V5391, V6546)

Ischemic heart disease as the principal diagnosis

Resident hospitalizations for which the principal diagnosis given on the Patient Abstract System (PAS) of inpatient records was ischemic heart disease.

International Classification of Diseases (ICD-9-CM) codes from 410 to 414, and 4292), and any secondary diagnosis was diabetes or a diabetes-related problem (ICD-9-CM codes 250, 7902, 7915, 7916, V4585, V5391, V6546

Lower extremity condition as the principal diagnosis

Resident hospitalizations for which the principal diagnosis given on the Patient Abstract System (PAS) of inpatient records was lower extremity condition.

International Classification of Diseases (ICD-9-CM) codes 355, 454, 2507, 4402, 4423, 4438, 4439, 7071, 6806, 6807, 6811, 6826, 6827, 3371, 3572, 3381, 3572, 3581, 7135, 0940, 2506, 7854, 71105 - 71107, 73005 - 73007, 73015 - 73017, 73025 - 73027, 73035 - 73037, 73085 - 73087, 73095 - 73097, 44422), and any secondary diagnosis was diabetes or a diabetes-related problem (ICD-9-CM codes 250, 7902, 7915, 7916, V4585, V5391, V6546).

Lower extremity amputation

Resident hospitalizations for which the principal procedure given on the Patient Abstract System (PAS) of inpatient records was lower extremity amputation.

International Classification of Diseases (ICD-9-CM) code 84.1), and any diagnosis was diabetes or a diabetes-related problem (ICD-9-CM codes 250, 7902, 7915, 7916, V4585, V5391, V6546)

Acute myocardial infarction (AMI)

Resident hospitalizations for which the principal diagnosis given on the Patient Abstract System (PAS) of inpatient records was acute myocardial infarction.

International Classification of Diseases (ICD-9-CM) code of 410), and any secondary diagnosis was diabetes or a diabetes-related problem (ICD-9-CM codes 250, 7902, 7915, 7916, V4585, V5391, V6546)

Acute cerebrovascular disease

Resident hospitalizations for which the principal diagnosis given on the Patient Abstract System (PAS) of inpatient records was cerebrovascular disease.

International Classification of Diseases (ICD-9-CM) codes from 430 to 432, 434, 436, 3446, 43301, 43311, 43321, 43331, 43381 and 43391), and any secondary diagnosis was diabetes or a diabetes-related problem (ICD-9-CM codes 250, 7902, 7915, 7916, V4585, V5391, V6546)

Chronic renal failure

Resident hospitalizations for which the principal diagnosis given on the Patient Abstract System (PAS) of inpatient records was chronic renal failure.

International Classification of Diseases (ICD-9-CM) codes of 585, 5853, 5854, 5855, 5856, 5859, 7925, V420, V451 and V56), and any secondary diagnosis was diabetes or a diabetes-related problem (ICD-9-CM codes 250, 7902, 7915, 7916, V4585, V5391, V6546)

Mortality

Diabetes as underlying cause

Resident deaths during the eleven-year period specified for which the underlying cause of death was given on the death certificate as diabetes.

International Classification of Diseases (ICD-10) codes: E10-E14.9.

Diabetes as underlying or contributing cause

Resident deaths for which diabetes was listed on the death certificate as having played any role in causing the death. This includes deaths for which diabetes was the underlying cause (the indicator above), those for which diabetes resulted from the underlying cause, and those for which diabetes was a significant condition contributing to the death but not resulting from the underlying cause.

Any International Classification of Diseases (ICD-10) code E10-E14.9 mentioned either as the underlying or as any contributing cause.