American Diabetes Month: Local Health Departments Work to Mitigate the Burden of Diabetes Across the Nation

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston

Today, over 30 million people in the United States live with diabetes—the seventh leading cause of death in the nation.1 Every day, local health departments (LHDs) work with community partners including schools, city planners, businesses, and restaurants to educate the public about diabetes and develop programs and policies to aid prevention, screening, and management.

November is American Diabetes Month, a time for the nation’s LHDs and other healthcare organizations to bring awareness to their efforts in preventing, screening, and managing diabetes.

The Burden of Diabetes in the United States

According to the 2017 National Diabetes Statistics Report, 30 million people in the U.S. have diabetes—that’s over 9% of the U.S. population.1 In 2014, approximately “14.2 million emergency department visits were reported with diabetes as any listed diagnosis among adults aged 18 years or older.”1 In 2015,, approximately 80,000 death certificates listed diabetes as the underlying cause of death.1 Adults with diabetes have a 50% greater risk of premature death than adults without diabetes.

Minorities have a greater risk for being diagnosed with type 2 diabetes. Additionally, people who are overweight, have high blood pressure, have a family history of gestational or type 2 diabetes, are over 45 years old, or are physically active less than three times per week are at a higher risk for getting diabetes.

Medical expenses for people living with diabetes is double compared to those without. In 2012, the total estimated cost of diagnosed diabetes in the U.S. was $245 billion. On average, the medical costs for a person with diabetes totaled $13,700, with $7,900 attributed to the disease.1 High blood sugar levels damage blood vessels and nerves, resulting in harm to vital organs, like kidneys. People with diabetes have a greater risk for experiencing serious health complications including heart disease and stroke, blindness and other eye issues, renal failure, and possible amputations.

Local Health Departments Support Diabetes Control and Prevention

Nationwide, LHDs play a critical role in arresting and reversing the diabetes epidemic. The Frederick County Health Department (FCHD) in Maryland developed the Power to Prevent Diabetes Prevention Program to reduce the number of residents who develop type 2 diabetes, and prevent or delay the health complications associated with the disease. This 2011 award winning model practice also implemented an environmental change component called the “Frederick Restaurant Challenge” in which participating restaurants offered healthy meal options for people with diabetes. This initiative gave diners the opportunity to rate their dishes, and the restaurants with the highest rating won an award. Objectives of the program included having overweight participants lose 5-7% of their body weight, getting participants to be physically active for at least 30 minutes per day, five days per week, and helping to find a medical home for participants who haven’t seen a healthcare provider in the past year. FCHD’s prevention program activities that supported their objectives included the 12-week Power to Prevent Classes, sessions with a registered dietician, and food activity tracker tools.

At my health department, we are attempting to bend the diabetes curve with our Healthy Living Matters (HLM) program. This program mobilizes policy action to reduce childhood obesity, often a precursor diabetes as an adult. With an estimated 34% of children in Harris County being overweight/obese, our community faces a significant health burden. Without action, many of these children will go on to develop type 2 diabetes and other sequelae of obesity.

With such a large fraction of our children being overweight, HLM decided to focus on policy. Our focus on policy means that any success will reach large numbers of the population. Our efforts are multi-prong and focus on where kids eat, play, and learn. We encourage use of available public lands in Harris County for the development of community gardens and farmers’ markets. We also are partnering with Harris County School Health Advisory Councils to support policy that requires physical activities subcommittees and recommendations for joint-use agreements and community/school partnerships. And we are promoting outdoor classrooms and the incorporation of active learning into core curriculum subjects to increase physical activity in Harris County school districts.

Our goal is to focus on prevention. If we can teach children healthy habits, work within communities to change policy, and leverage the skills of our partners, our children have a chance to grow up into healthy adults. It truly does take a village and with the health department leading these improvements, it will lead to healthier outcomes of lowered obesity and less diabetes for our community. It will have an additional benefit of reducing the total cost of care within our community, as fewer people will need to pay for the expensive complications that arise from being obese or diabetic.

NACCHO Assists Local Health Departments in Prevention and Control Efforts

NACCHO has many resources dedicated to the prevention and management of diabetes. The “Local Health Departments’ Capacity to Prevent and Control Diabetes in Priority Populations” research brief highlights the results of the Centers for Disease Control and Prevention’s (CDC’s) Diabetes Today training, delivered by NACCHO at 36 LHDs. The program was designed to assist public health professionals in developing a strategic and effective plan for addressing diabetes. The research brief explains the methodology; discusses the impact of the training, challenges and barriers, resource needs, and collaborations; and highlights dissemination activities.

As part of the CDC’s National Diabetes Prevention Program (NDPP) Local Sub-Awardee Community of Practice Project, NACCHO has compiled details from three practices that have worked with CBOs and healthcare providers to integrate the NDPP into clinical and community systems of care. The success stories of the three practices — PartnerSHIP 4 Health in Minnesota, ProMedica Bixby Hospital in Michigan, and the Salt Lake County Health Department in Utah — all highlight their progress in scaling and sustaining the project.

NACCHO offers several applicable policy statements that LHDs can tailor to their programs regarding issues including obesity prevention, access to healthy food, and healthy community landscapes. Additionally, NACCHO’s toolbox houses many replicable practices dedicated to the prevention and management of chronic diseases, including diabetes.

Adopting a Healthy Lifestyle Makes a Difference

With the current trend in incidence and prevalence of diagnosed diabetes in the U.S., as many as one in three adults could have diabetes by 2050. There are many steps people can take to prevent being diagnosed with diabetes and greatly reduce their risk of diabetes-related health problems, including:

  • Eating more fruits and vegetables and reducing salt and sugar intake;
  • Getting physically active;
  • Checking blood sugar regularly;
  • Taking diabetes medicine as prescribed;
  • Stopping or not starting to smoke; and
  • Making regular visits to a healthcare provider.

Throughout American Diabetes Month, NACCHO encourages the nation’s LHDs to raise awareness of diabetes and continue to develop innovative, sustainable, and effective programs that reduce the prevalence of this disease in their communities.



Model Practice – Frederick County Health Department’s Power to Prevent Diabetes Prevention Program

CDC Diabetes At A Glance Fact Sheet

CDC Diabetes Information Homepage

NACCHO’s Diabetes Webpage


  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2017.