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Diabetes in Canada:

Diabetes in Canada:. Today & Tomorrow CFPM 9 th Annual Clinical Conference Friday, 5 December 2008 2:30 p.m. Presentation by Karen Philp, Vice President Public Policy & Government Relation. Diabetes today. Is a global pandemic. 30 million people lived with diabetes in 1980.

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Diabetes in Canada:

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  1. Diabetes in Canada: Today & Tomorrow CFPM 9th Annual Clinical Conference Friday, 5 December 2008 2:30 p.m. Presentation by Karen Philp, Vice President Public Policy & Government Relation

  2. Diabetes today • Is a global pandemic. • 30 million people lived with diabetes in 1980. • 250 million living with diabetes in 2008. • 350 million projected to have diabetes by 2030. • Affects people & governments. • One person dies every 10 seconds. • 4 million deaths each year attributed to diabetes. • US$232 billion to treat diabetes & its complications in countries around the world in 2007. • $174 billion impact on US economy in 2007.

  3. Diabetes in Canada today • 2.4 million Canadians diagnosed in 2005. • 7 Canadians diagnosed with diabetes every hour, every day, every year. • More than 700,000 have diabetes, but don’t know it. • More Canadians live with diabetes today • than WHO predicted for 2030! • 2.34 million Canadians diagnosed in 2005. • 7 Canadians are diagnosed with diabetes every hour, every day. • More than 700,000 have diabetes, but just don’t know it yet! • 1 in every 11 Canadians has diabetes today. • More people than World Health Organization predicted to be diagnosed with diabetes in Canada by 2030!

  4. Diabetes is complicated • Diabetes leads to 1 or more serious complications over a lifetime. • 80% of Canadians with diabetes die from a heart attack or stroke. • 42% of new kidney dialysis patients in 2004 were the result of diabetes. • 30% of Canadians with diabetes will become blind. • 7 out of 10 non-traumatic limb amputations are the result of diabetes. • 25% of people with diabetes suffer from depression.

  5. Diabetes is deadly • The life expectancy of someone with diabetes is reduced by 13 years. • Canada ranks 3rd in the world for deaths due to diabetes. • Conference Board of Canada report in June 2007 states the current & future impact on the economy requires a “new business model for health care based on chronic disease prevention & management…”

  6. Diabetes impacts our healthcare system Diabetes & other chronic diseases account for almost 80% of all direct acute healthcare spending in Canada.

  7. Prevention is the best option • Prevention of modifiable risk factors for type 2 diabetes is the best investment to slow, halt & ultimately reverse the rising numbers of people diagnosed with type 2 diabetes. • While greatest risk for type 2 diabetes remains genetic, estimates are that over 50% of type 2 diabetes may be delayed – or prevented – with healthier eating, increased physical activity & the elimination of smoking.

  8. It will be a serious challenge though

  9. The tsunami • 4 million Canadians diagnosed • with pre-diabetes today. • 50% will develop type 2 diabetes. • Demographics of aging baby-boomers. • Inactive lifestyles = overweight & obese Canadians = greater risk for type 2 diabetes. • Growing income inequality & immigration. • Smoking.

  10. However, until there is a cure… Why should you care?

  11. Diabetes affects every one of us • 1 in 10 hospital admissions is to treat diabetes & its complications. • 280,330 hospital admissions in 2005/06. • direct cost to treat diabetes in our health care system is $5.6 billion a year. • 75% jump in costs is predicted by 2016. • diabetes is an estimated $17.4 billion cost to Canada’s economy & productivity.

  12. Fortunately we know what to do • Since 1998, we have known that achieving recommended clinical targets for blood glucose, cholesterol & blood pressure levels helps avoid or delay diabetes complications. • For every 1% reduction in A1c levels, there is a • 37% decrease in the risk of damage to blood vessels. • 14% drop in heart attack rates. • 21% drop in deaths due to type 2 diabetes.

  13. The evidence is clear Effective diabetes care supported by evidence-based clinical practice guidelines within an interdisciplinary health team setting optimizes health outcomes for people living with this chronic disease.

  14. The reality is quite different • Fewer than 50% of Canadians with type 2 diabetes are at the recommended clinical target for their A1c’s. • Nearly 60% of Canadians with diabetes do not know what their recommended A1c target level should be (7 or lower). • Less than 50% of people with type 2 diabetes are regularly tested for A1c levels, blood pressure, cholesterol or kidney function.

  15. The reality today • Majority of Canadians with type 2 diabetes not receiving diabetes education or support. • Recent survey showed, Ontarians with diabetes receive support from 3 primary sources: • Family doctor (42%) • 91% cite medical support • 65% cite advice & moral support • 43% get diabetes education • 5% report blood tests • 1% get prescriptions for medications

  16. The reality today cont’d… • Diabetes Education Centre (30%) • 91% state they receive information on diabetes • 91% receive diabetes education • 75% receive advice & moral support • 50% get medical support • Partners or spouses (30%) • 94% cite advice & moral support • 30% receive information • 30% receive medical support • 17% get diet/food assistance • 2% exercise

  17. People with diabetes should have • an A1c test every 3 months to monitor blood glucose levels; • a lipid test at least once every 3 years to check cholesterol levels; • regular blood pressure checks; • a regular eye exam to check for retinopathy; and • regular foot exams & assessments for the early signs of kidney disease. Nearly 50% of Canadians with diabetes are not receiving these recommended regular exams!

  18. Effective diabetes management • To manage diabetes & avoid serious complications, people with diabetes need: • on-going diabetes education & support from a diabetes care team; • prescribed medications to control A1c levels, blood pressure & cholesterol levels; • test strips to monitor their blood glucose daily to adjust their medications if required; and • healthy food choices, daily physical activity & stop smoking supports.

  19. Medication management • On average, Canadians with diabetes take up to 8 prescription medications daily. For example: • insulin for type 1 & up to 40% of type 2 diabetes; • 2 anti-hyperglycaemic oral medications for T2DM. • 1 or 2 anti-hypertensive medications to regulate blood pressure; • ACE inhibitors to protect kidneys; • Statins to lower lipids; • Low dose aspirin (ASA) for anti-platelet therapy.

  20. Diabetes therapy • Canadians with diabetes may also require: • Blood glucose test strips; • Monitors; • Lancets; • Insulin pens or needles; and • Insulin pumps & supplies.

  21. The challenges • It matters where you live in Canada if you have diabetes. This contributes to 57% of Canadians saying they don’t comply with their prescribed therapy. Why? • Access to medications, devices & supplies; • Cannot afford the cost of medications, devices & supplies; • Access to health professionals; and • Lack of knowledge or access to diabetes education & on-going support to know what to do.

  22. Implications for governments • Sustainability of public health care system. • 2007 = $160,133,500,000 • Encouraging shift from acute care model to chronic disease management framework. • Primary care reforms = health teams • Regional health units = greater accountability for $ • Enhanced role for other health professionals • Pharmacists, nurse practitioners, home care • Patient self-management or self-care • E-health records & databases

  23. Implications for Public Drug Plans • Attempts to limit cost escalation by public drug plans. • F/P/T process: Common Drug Review, COMPUS, National Pharmaceutical Strategy. • Provincial: revising legislation (Ontario, NL, NB & Alberta, BC Pharmaceutical Task Force). • Examining bulk purchase or alternative purchasing models. • Attempts to improve prescribing practices • Academic modelling • Pharmacists – Ontario’s MedCheck program • Prescribing guidelines

  24. Our Association’s thoughts • 4 million Canadians have drug expenses exceeding 3% of their income. • 51% of all seniors. • 8% of non-seniors. • Drug costs which exceed 3% of family income (i.e. catastrophic) total $6.9 billion or 42% of all costs. • 57% of costs for seniors. • 33% of costs for non-seniors. • Those Canadians with drug expenses exceeding 3% of their income account for 66% of all out-of-hospital drug costs. • 85% for seniors. • 53% for non-seniors.

  25. Our Association believes • Canada needs a National Catastrophic Drug Plan that ensures: • all Canadianseligible if spending more than 3% of adjusted family income each year on medications prescribed by their physician. • all medications, devices & supplies covered if approved safe, effective & for sale in Canada. • All provinces & territories are able to participate fully with adequate financial support from federal government.

  26. Our Association believes • A National Catastrophic Drug Plan will: • end the disparities in access to diabetes medications & supplies. • ensure Canadians with diabetes manage effectively, live healthier & more productively. • reduce costly, long-term complications. • relieve growing pressures on our healthcare system & advance healthcare sustainability.

  27. How can you help? Personally….

  28. Work with us and we can change Things for the better.

  29. Any questions? Thank you! If you have any further questions, please contact: Karen Philp, Vice President Public Policy & Government Relations Canadian Diabetes Association Phone 416-408-7041 or E-mail:Karen.Philp@diabetes.ca

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