title: South Carolina 20 Years of Diabetes--A Public Health Concern.
abstract: OBJECTIVE
  To assess and enumerate the trends in diabetes prevalence, morbidity and mortality rates in South Carolina (SC) within the past 2 decades.
  
  
  METHODS
  We analyzed state-level data from vital records, Behavioral Risk Factor Surveillance System, Children's Health Assessment Survey and Administrative Claim Files.
  
  
  RESULTS
  Over the past 20 years, there has been an average 2.5% annual increase in diabetes prevalence among adults in SC (P < 0.01). Although a typical reduction in mortality rate of 2.2% has been observed during the same period, the increased number of people living with diabetes (from 5.0% in 1995 to 12.0% in 2014) has brought more need for diabetes care, particularly for severe in-hospital cases and cases with crisis at the emergency department, totaling $404 million in annual costs.
  
  
  CONCLUSIONS
  SC has experienced an epidemic of diabetes. Coupled with declining trends in mortality and increased hospitalization and emergency department visits, the state is experiencing historical morbidity and complications due to diabetes. The shift in complexity of the disease onset and management has resulted in more individuals living with cardiovascular disease and other comorbidities. The cost of care for all South Carolinians with diabetes is estimated to exceed 2.8 billion dollars in 2014 and projected to be more than 4 billion dollars by 2020. If the diabetes prevalence trend of increasing rates continues over the next 20 years, the number of individuals living with diabetes and its complications would rise to 1.3 million in SC.
authors.affiliation: South Carolina Department of Health and Environmental Control, Columbia, South Carolina. Electronic address: heidarik@dhec.sc.gov.
authors.forename: Khosrow
authors.initials: K
authors.lastname: Heidari
authors.affiliation: South Carolina Department of Health and Environmental Control, Columbia, South Carolina; Department of Exercise Sciences, University of South Carolina School of Public Health, Columbia, South Carolina; Department of Epidemiology & Biostatistics, University of South Carolina School of Public Health, Columbia, South Carolina.
authors.forename: Charity B
authors.initials: CB
authors.lastname: Breneman
authors.affiliation: South Carolina Department of Health and Environmental Control, Columbia, South Carolina.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Barton
authors.affiliation: South Carolina Department of Health and Environmental Control, Columbia, South Carolina; Department of Epidemiology & Biostatistics, University of South Carolina School of Public Health, Columbia, South Carolina.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fogner
authors.affiliation: South Carolina Department of Health and Environmental Control, Columbia, South Carolina.
authors.forename: Kate
authors.initials: K
authors.lastname: Callahan
authors.affiliation: South Carolina Department of Health and Environmental Control, Columbia, South Carolina; Core for Applied Research & Evaluation, University of South Carolina School of Public Health, Columbia, South Carolina.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Diedhiou
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000639:trends*; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D011634:Public Health / Q000639:trends*; D057566:Self Report; D013022:South Carolina / Q000453:epidemiology
keywords: Diabetes comorbidity and diabetes prevalence; Diabetes hospitalization; Diabetes mortality