Jeffrey A. Johnson, PhDStephanie U. Vermeulen, MSc.
University of Alberta & Institute of Health Economics
April 8, 2008
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 they produce.
Problematic because insulin is required to move glucose into cells so that it can be used by body tissues and organs.
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 5-10% 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 90-95% 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 5% of Canadians over 20 years of age.
Healthcare costs of patients with diabetes are projected to be in excess of $6 billion in 2006.
As people are getting diabetes earlier in life, they are also getting complications earlier in life.
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
National Diabetes Surveillance SystemNational Diabetes Surveillance System
ADSSADSS
AHW & IHE/ACHORD partnership Deliverables
ADSS Newsletter Regular updates and issue-specific focus
Alberta Diabetes Atlas 2007, 2009, 2011
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)
Alberta Diabetes PrevalenceAlberta Diabetes PrevalenceAge-Specific Rates, 2006Age-Specific Rates, 2006
Alberta Diabetes Prevalence Alberta Diabetes Prevalence Age-Adjusted Rates, 2006Age-Adjusted Rates, 2006
Alberta Average: 4.4%
Northern Lights Average: 5.3%
Diabetes Prevalence in Northern Lights Diabetes Prevalence in Northern Lights
(Age-Adjusted Rates)(Age-Adjusted Rates)
Diabetes Prevalence in Northern LightsDiabetes Prevalence in Northern Lights(Case Counts)(Case Counts)
Prevalence Rates by Community Prevalence Rates by Community (Age-Adjusted) 2006(Age-Adjusted) 2006
Diabetes Prevalence Diabetes Prevalence (Case Counts) 2006(Case Counts) 2006
Diabetes Incidence Diabetes Incidence (Case Counts) 1995-2006(Case Counts) 1995-2006
Diabetes Incidence by CommunityDiabetes Incidence by Community (Case Counts) 2006(Case Counts) 2006
Incidence Rates by CommunityIncidence Rates by Community (Age-Adjusted) 2006 (Age-Adjusted) 2006
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
Northern Lights Average =9.7
Northern Lights Average = 2.2
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)
Northern Lights Diabetes Average = 1.4
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
Introduction of TeleopthalmologyNorthern Lights
Crude Rates of Eye Examination for Northern Lights, 1995-2005
Crude Rates of Retinal Laser Treatment for Northern Lights,
1995-2005
KEY FINDING POLICY OPTIONS
6. Screening for diabetic eye disease is an important strategy in preventing blindness; despite
strong evidence, the frequency of eye examinations by experienced
professionals is lower than suggested by practice guidelines.
• Increase awareness of the need for regular eye examinations by actively disseminating the
guidelines to both patients and providers.
• Enhance surveillance to include care provided by all eye care professionals.
• Consider increased use of teleophthalmology to enhance access for required eye
examinations in northern and non-metro health regions.
Key Findings and Policy Options:Eye Disease
Crude ESRD by Region (2005)
Prevalent ESRD Cases by Region (2005)
Kidney TransplantationProportion of DM vs. no DM
Diabetes and Special Populations
Diabetes Prevalence Rate=8.3%
Diabetes and First Nations
Age-Specific Diabetes Prevalence among First Nations, 2005
Age Group (Years)
Other topics included:
DM & Lower Limb Amputation
DM & Mental Health- Affective disorders- Anxiety disorders- Psychoses (organic & non-organic)- Substance abuse disorders
Alberta Diabetes Atlas 2007
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.
Key Findings and Policy Options
Alberta Diabetes Fact Sheet 2008
Conditions: DM & pregnancy DM & foot disease DM & cancer
New data: Laboratory surveillance Drug Utilization Risk factor surveillance
What is missing? What is next?
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.
How can YOU use the ADSS?
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
ADSS Dissemination
ADSS WebsiteADSS Website
General Information about the ADSS________________________________________________
_____________________________________________
ADSS Findings Alberta Diabetes Atlas Key Findings & Policy Options Atlas Figures in PowerPoint Diabetes Rates by AB Community (Map) ADSS Newsletters
ADSS Publications/Presentations
ADSS Team ADSS on the move Funding Sources Contact Us
REPORTS FROM DATABASE
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
REPORTS FROM DATABASE
ADSS Website- Interactive AspectADSS Website- Interactive Aspect
DM Incidence
Primary Prevention Intervention
Control No Intervention
ADSS: Health Research PotentialADSS: 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 MessagesKey Messages
Average Provincial Rate = 0.23
Crude Diabetes Prevalence Rates (U20) by Region, 2005
Crude Diabetes Prevalence Rates (U20) in First Nations, 2006