Jeffrey A. Johnson, PhD Stephanie U. Balko, MSc. University of Alberta &

Jeffrey A. Johnson, PhDStephanie U. Balko, MSc.University of Alberta &

Institute of Health Economics

March 4, 2009

Alberta Diabetes Atlas 2007 provides trends over time, across age and regional variation for DM & related conditions.

The prevalence & incidence of DM are increasing in Alberta, and especially among older adults.

People with DM have significantly higher rates of CV disease, eye disease, kidney disease, mental health disorders and overall health care use than people without diabetes.

Better primary care can reduce the burden on acute care

Local information will help local planning.

Key Messages…

Diabetes- Background Info.Diabetes- Background Info.

Body has difficulty making insulin and/or using the insulin that it produces.

Problematic because insulin is required to move glucose into cells so that it can be used by body tissues and organs.

Without insulin action, glucose remains in blood.

Diabetes- Background Info.Diabetes- Background Info.

When glucose remains in the blood, blood glucose levels can rise to dangerously high levels and result in acute complications.

Higher than normal blood glucose levels also can result in long-term organ damage and affect the eyes, kidneys and cardiovascular system.

Diabetic Retinopathy

End-Stage Renal Disease

Cardiovascular Disease

Usually occurs early in life during childhood or adolescence and is managed with insulin.

Accounts for approximately 5% of all diabetes cases.

Type 1 DiabetesType 1 Diabetes

Usually associated with onset after 30-40 years of age; however during the past decade, it has become much more prevalent in younger individuals.

Associated with many complications such as heart problems, kidney problems, eye disease etc.

Thought to be associated with lifestyle factors including physical inactivity and obesity.

Accounts for 95% of all diabetes cases.

Type 2 DiabetesType 2 Diabetes

Diabetes - Big Picture, Big BurdenDiabetes - Big Picture, Big Burden

Is a chronic disease affecting more than 7% of Canadians over 20 years of age.

Healthcare costs of patients with diabetes were projected to be in excess of $6 billion in 2006.

As people are getting diabetes earlier in life, they are also getting complications earlier.

ADSS – A Public Health Service…ADSS – A Public Health Service…

“Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know. . . . A surveillance system includes a functional capacity for data collection, analysis and dissemination…”

-CDC Surveillance Update, 1988

Create nationally comparable data: Base epidemiological measures

(incidence, prevalence, mortality) complications health services utilization

Enhance capacity for Diabetes Surveillance Provincial / Territorial Aboriginal communities

Administrative Data

National Diabetes Surveillance System (NDSS)National Diabetes Surveillance System (NDSS)

Mortality

12

Demographic Data

Data SourcesData Sources

Hospital PhysicianInsurance Registry

GPSpecialist

Age

Gender

Location of Residence

Status Aboriginal

Co-Morbidities/Procedures

DM StatusIncident/Prev

DM StatusIncident/Prev

Co-Morbidities/Procedures

National Diabetes Surveillance System (NDSS)National Diabetes Surveillance System (NDSS)

ADSSADSS

AHW & IHE/ACHORD partnership Deliverables

Alberta Diabetes Atlas 2007, 2009, 2011

ADSS Newsletter Regular updates and issue-specific focus

ADSS Website Timely, region-specific information

Alberta Diabetes Atlas 2007Alberta Diabetes Atlas 2007

Acknowledgments

1. Background & Methods

2. Epidemiologic Trends, 1995-2005

3. DM & Health Care Utilization

4. DM & Cardiovascular Disease

5. DM & Lower Limb Amputations

6. DM & Kidney Disease

7. DM & Eye Disease

8. DM & Mental Health

9. DM & First Nations People

10. Key Findings & Policy Options

Glossary

Alberta Diabetes PrevalenceAlberta Diabetes Prevalence(Age-Adjusted Rates)(Age-Adjusted Rates)

Alberta Diabetes PrevalenceAlberta Diabetes Prevalence(Case Counts)(Case Counts)

Alberta Diabetes IncidenceAlberta Diabetes Incidence(Case Counts)(Case Counts)

Age-Specific DM Prevalence Rates, 2007Age-Specific DM Prevalence Rates, 2007

Age-Specific DM Prevalence Rates, 1997 and 2007Age-Specific DM Prevalence Rates, 1997 and 2007

>60% Increase

Alberta Diabetes Prevalence Alberta Diabetes Prevalence Age-Adjusted Rates, 2006Age-Adjusted Rates, 2006

Diabetes Prevalence in David ThompsonDiabetes Prevalence in David Thompson(Case Counts)(Case Counts)

Prevalence Rates by Community Prevalence Rates by Community (Age-Adjusted) 2007(Age-Adjusted) 2007

Diabetes Prevalence Diabetes Prevalence (Case Counts) 2007(Case Counts) 2007

Diabetes Incidence in David ThompsonDiabetes Incidence in David Thompson(Case Counts)(Case Counts)

Diabetes Incidence in David ThompsonDiabetes Incidence in David Thompson(Age-Adjusted Rates)(Age-Adjusted Rates)

Incidence Rates by CommunityIncidence Rates by Community (Age-Adjusted) 2007 (Age-Adjusted) 2007

Diabetes Incidence by CommunityDiabetes Incidence by Community (Case Counts) 2007(Case Counts) 2007

Diabetes & MortalityDiabetes & Mortality(Age-Adjusted Rates)(Age-Adjusted Rates)

Physician VisitsPhysician Visits (1995-2005)(1995-2005)

GeneralPractitioners

Specialists*

Physician Visits by RegionPhysician Visits by Region(2005)(2005)

Specialists*

GeneralPractitioners

DTHR Average =9.7

DTHR Average

= 3.2

Emergency Department Visits Emergency Department Visits (Age/Sex Adjusted, 1998-2005)(Age/Sex Adjusted, 1998-2005)

Total Number of ED Visits for People Total Number of ED Visits for People with Diabetes with Diabetes (1998-2005)(1998-2005)

Emergency Department Visits by RegionEmergency Department Visits by Region

(2005)(2005)

DTHR Diabetes Average = 1.7

Hospital DaysHospital Days(Age/Sex Adjusted, 1995-2005)(Age/Sex Adjusted, 1995-2005)

Hospitalization Days by RegionHospitalization Days by Region(Age/Sex Adjusted, 2005)(Age/Sex Adjusted, 2005)

DTHR Diabetes Average = 2.8

Diabetes & CVDAcute Coronary Syndrome, 1995-2005

Diabetes & CVDAcute Coronary Syndrome, 1995-2005

Diabetes & CVD Age-Adjusted Rates of Acute Coronary Syndrome by Region, 2005

Diabetes & Eye DiseaseEye Examinations*, 1995-2005

* Eye examinations by an Ophthalmologist

Diabetes & Eye DiseaseEye Examinations*, 2005

* Eye examinations by an Ophthalmologist

Diabetes and Special PopulationsDiabetes and Special Populations

Diabetes and First NationsDiabetes and First Nations

Diabetes Prevalence Rate=14.4%

First Nations people living in David

Thompson have among the highest rates of

diabetes – among those FN who are >65 years,

rates are 35%.

Under 20: Crude Diabetes Prevalence Rates by Region, 2005

Average Provincial Rate = 0.23

Alberta Diabetes Atlas 2007

Other topics included:

DM & Lower Limb Amputation

DM & Kidney Disease- Incidence & prevalence of ESRD- Kidney transplants

DM & Mental Health- Affective disorders- Anxiety disorders- Psychoses (organic & non-organic)- Substance abuse disorders

DM & First Nations People

Alberta Diabetes Atlas 2007Key Findings & Policy Options

Key Findings & Options:

1. Primary prevention to reduce rising prevalence.

2. Secondary prevention to reduce complications.

3. Enhance Quality of Primary Care.

4. Enhance Access to Primary Care.

5. Recognize mental health burden.

6. Enhanced eye care for diabetes.

7. Diabetes in First Nations People.

8. Enhance scope and depth of DM surveillance.

Alberta Diabetes Fact Sheet 2008

ADSS - what is missing…?- what is next…?

Conditions: DM & pregnancy DM & foot disease DM & cancer

New data: Laboratory surveillance Drug Utilization Risk factor surveillance

How YOU can use the ADSS…How YOU can use the ADSS…

ADSS can be used by the Regions to more accurately assess what the burden of DM and it’s comorbidities are.

ADSS provides important information and specific numbers that can be included in Regional Health Authority business plans/performance reports.

Diabetes is one of the conditions expected in performance reports for all health regions in Alberta.

ADSS can help regions plan and evaluate new programs.

ADSS Dissemination*ADSS Dissemination*

1. Active dissemination to Regions: Local presentations

Regional Administration MOH/PCNs/DECs Public

2. Ongoing Newsletters

3. ADSS Website

*ADSS Dissemination Sub-Committee: J. Johnson, C. Andres, A. Edwards, K. McLaughlin, R. Lewanczuk

www.albertadiabetes.ca

ADSS Website: Search CriteriaADSS Website: Search Criteria

All of Alberta

Regional Health Authority

Sub-Region

Community

Both Sexes

Male

Female

All Ages

20-34 years

35-49 years

50-64 years

65-74 years

75 + years

Rates/Cases from

1995-2005

DM alone or DM & Disease

First Nations Status

DM Incidence

Primary Prevention Intervention

Control No Intervention

ADSS – Health Research Potential …ADSS – Health Research Potential …

Alberta Diabetes Atlas 2007 provides trends over time, across age and regional variation for DM & related conditions.

The prevalence & incidence of DM are increasing in Alberta, and especially among older adults.

People with DM have significantly higher rates of CV disease, eye disease, kidney disease, mental health disorders and overall health care use than people without diabetes.

Better primary care can reduce the burden on acute care

Local information will help local planning.

Key Messages…

Questions…???Questions…???

jeff.johnson@ualberta.castephanie.vermeulen@ualberta.ca

www.ACHORD.ca