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Diabetes mellitus is one of the leading causes of disability and death in the United States. The rate of diabetes has increased six-fold over the past four decades. The Centers for Disease Control and Prevention report that approximately 16 million people in the United States have diabetes and one third of them remain undiagnosed. In severe cases, diabetes can lead to debilitating complications including blindness, kidney failure, cardiovascular disease, mobility problems and lower extremity amputation.

In Los Angeles County, diabetes is the seventh leading cause of death (12.9 deaths per 100,000 population in 1997). Although the specific causes of diabetes remain elusive, both genetics and environmental factors appear to be important. Type I diabetes (insulin-dependent) accounts for 5–10% of those with diabetes and most often occurs during childhood or adolescence. Type II diabetes (non-insulin dependent) is the more common type, affecting 90%–95% of those with diabetes and usually occurs in adulthood, although a recent increase has been seen among adolescents. Obesity and lack of physical activity are both major risk factors for Type II diabetes.

In order to reduce the risk of developing diabetes, public health efforts should focus on preventing obesity by promoting regular physical activity and diets low in fat and high in complex carbohydrates and fiber. Among persons with diabetes, access to health care is critically important to ensure optimal treatment and prevention of complications.

Since these findings are based on self-reports, the prevalence estimates do not include those who have diabetes and remain undiagnosed. Women with pregnancy-related diabetes are also not included in the estimates. In addition, the results do not distinguish between Type I and Type II diabetes.

Findings:
> The overall prevalence of diagnosed diabetes in Los Angeles County adults is 7% (an estimated 474,000 people age 18 or older).

> The percentage and number of adults with diabetes among the county’s Service Planning Areas are as follows:
> The prevalence of diabetes is similar for men (6%) and women (7%) and increases with advancing age, from 3% in 30–39 year olds, to a peak of 17% in 65 years and older (see Figure 1).

> Among adults aged 40 years and older, the prevalence of diabetes is significantly higher among Latinos (16%) and African Americans (13%) than among Whites (8%) and Asian/Pacific Islanders (8%). These differences are consistent with the national pattern (Figure 2).
> 21% of extremely obese adults have been diagnosed with diabetes compared to 4% of adults who are normal weight (Figure 3).

> Regular physical activity is important not only for the prevention of diabetes, but also for managing the condition. Adults with diabetes are more likely to be sedentary (61%) than adults who do not have diabetes (40%). (Figure 4).
> Regular health care is also important for managing diabetes and related health problems. While relatively few adults with diabetes (9%) lack a regular source of health care, those who are Latino are significantly more likely (16%) than those who are African-American (3%), White (4%) or Asian/Pacific Islander (6%) to lack a regular source of care.

> 32% of non-elderly adults (ages 18–64) with diabetes are uninsured.

> 25% of adults with diabetes are not currently under a doctor’s care for their condition. Among those with diabetes who are uninsured, 51% are not currently under a doctor’s care for their diabetes. Among those with health insurance, 20% are not under a doctor’s care.

Acknowledgements
Funding for the survey was provided by the Los Angeles County Department of Health Services, the California Department of Health Services, the Los Angeles County Medicaid Demonstration Project, and the Los Angeles County Department of Public Social Services.
This fact sheet is published by the Health Assessment Unit, Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services–Public Health.
Mark Finucane, Director, Department of Health Services
Jonathan Fielding, MD, MPH, Director of Public Health and Health Officer
Paul Simon, MD, MPH, Director, Office of Health Assessment and Epidemiology
Cheryl Wold, MPH, Chief, Health Assessment Unit
Health Assessment Unit staff: Amy Paturel, MS, MPH; Thomas Rice, MA; Meeran Ojha, MPH; Isabel Cardenas, MPH; Daniel Magana, MPH; Zhiwei Zeng, MD, MPH

For additional copies or information, call 213-240-7785 or visit our web site at www.publichealth.lacounty.gov.
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