Mapping U.S. national diabetes-related rates & resources using geographic information systems (GIS) and secondary data

Background: In order to efficiently help the U.S. manage diabetes, public health agencies need to be able to target high risk populations with low resources related to diabetes. To aid in this process, we mapped state-level diabetes-related rates and resources to determine regional clusters with high diabetes rates and low diabetes-related resources. Methods: We collected U.S. state data from secondary, web-based sources and mapped these using ArcGIS 10. Web sources included 2008 age-adjusted U.S. diabetes prevalence rates and number of adults with diabetes (Centers for Disease Control and Prevention), percent of Medicare patient who received HbA1C testing in the past year (Dartmouth Atlas of Healthcare, 2006-7), rate of existing 2011 certified diabetes self-management education programs per 1,000 residents with diabetes (DSME) (American Diabetes Association), as well as population estimates (U.S. Census). Low resource-high rate states were defined as having below U.S. average HbA1C testing and DSME rates per 1,000 residents with diabetes and above average diabetes rates. Results: HbA1c testing was highest in the Eastern part of the U.S., while the DSME rates were highest in the North, and diabetes rates were highest in the Southeast. The Southwest had low resources and rates, while many Northern states had high resources and low diabetes rates. A cluster of high diabetes rate-low resource states was identified in the Southeast. Conclusions: Use of public data and mapping tools can help identify states to target for diabetes-related education and medical care needs. Targeted interventions in the Southeast in particular are needed.