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

1. Jeffrey A. Johnson, PhD Stephanie U. Balko, MSc. University of Alberta & Institute of Health Economics March 4, 2009

2. Key Messages… • 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.

3. 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.

4. 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

5. Type 1 Diabetes • Usually occurs early in life during childhood or adolescence and is managed with insulin. • Accounts for approximately 5% of all diabetes cases.

6. Type 2 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.

7. Diabetes - 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.

10. 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 timelydissemination 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

11. National Diabetes Surveillance System (NDSS) • 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

12. Unique ID Unique ID Unique ID Health Services Health Services Data Sources Insurance Registry Hospital Physician GP Specialist Age Demographic Data Gender DM Status Incident/Prev DM Status Incident/Prev Status Aboriginal Mortality Co-Morbidities /Procedures Co-Morbidities /Procedures Location of Residence

13. National Diabetes Surveillance System (NDSS)

14. ADSS • 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

15. Alberta 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

17. Alberta Diabetes Prevalence(Age-Adjusted Rates)

18. Alberta Diabetes Prevalence(Case Counts)

19. Alberta Diabetes Incidence(Case Counts)

20. Age-Specific DM Prevalence Rates, 2007

21. Age-Specific DM Prevalence Rates, 1997 and 2007 >60% Increase

22. Alberta Diabetes Prevalence Age-Adjusted Rates, 2006

23. Diabetes Prevalence in David Thompson(Case Counts)

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

25. Diabetes Prevalence (Case Counts) 2007

26. Diabetes Incidence in David Thompson(Case Counts)

27. Diabetes Incidence in David Thompson(Age-Adjusted Rates)

28. Incidence Rates by Community (Age-Adjusted) 2007

29. Diabetes Incidence by Community (Case Counts) 2007

30. Diabetes & Mortality (Age-Adjusted Rates)

32. Physician Visits(1995-2005) General Practitioners Specialists*

33. Physician Visits by Region(2005) DTHR Average =9.7 General Practitioners DTHR Average = 3.2 Specialists*

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

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

36. Emergency Department Visits by Region(2005) DTHR Diabetes Average = 1.7

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

38. Hospitalization Days by Region(Age/Sex Adjusted, 2005) DTHR Diabetes Average = 2.8

40. Diabetes & CVDAcute Coronary Syndrome, 1995-2005

41. Diabetes & CVDAcute Coronary Syndrome, 1995-2005

42. Diabetes & CVDAge-Adjusted Rates of Acute Coronary Syndrome by Region, 2005

44. Diabetes & Eye DiseaseEye Examinations*, 1995-2005 * Eye examinations by an Ophthalmologist

45. Diabetes & Eye DiseaseEye Examinations*, 2005 * Eye examinations by an Ophthalmologist

46. Diabetes and Special Populations

47. Diabetes and First Nations First Nations people living in David Thompson have among the highest rates of diabetes – among those FN who are >65 years, rates are 35%. Diabetes Prevalence Rate=14.4%

48. Under 20: Crude Diabetes Prevalence Rates by Region, 2005 Average Provincial Rate = 0.23

49. 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

50. 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.