Jeffrey A. Johnson, PhD Stephanie U. Vermeulen, MSc. University of Alberta & Institute of Health Economics April 8, 2008.

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

Questions…???Questions…???

[email protected]@ualberta.ca

www.ACHORD.ca

Average Provincial Rate = 0.23

Crude Diabetes Prevalence Rates (U20) by Region, 2005

Crude Diabetes Prevalence Rates (U20) in First Nations, 2006