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

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

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

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 5-10% 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 90-95% of all diabetes cases

7. Diabetes - 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.

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

12. ADSS • 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

13. 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

15. Alberta Diabetes Prevalence(Age-Adjusted Rates)

16. Alberta Diabetes Prevalence(Case Counts)

17. Alberta Diabetes Incidence(Case Counts)

18. Alberta Diabetes PrevalenceAge-Specific Rates, 2006

19. Alberta Diabetes Prevalence Age-Adjusted Rates, 2006 Northern Lights Average: 5.3% Alberta Average: 4.4%

20. Diabetes Prevalence in Northern Lights (Age-Adjusted Rates)

21. Diabetes Prevalence in Northern Lights(Case Counts)

22. Prevalence Rates by Community (Age-Adjusted) 2006

23. Diabetes Prevalence (Case Counts) 2006

24. Diabetes Incidence (Case Counts) 1995-2006

25. Diabetes Incidence by Community (Case Counts) 2006

26. Incidence Rates by Community (Age-Adjusted) 2006

27. Diabetes & Mortality (Age-Adjusted Rates)

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

30. Physician Visits by Region(2005) Northern Lights Average =9.7 General Practitioners Northern Lights Average = 2.2 Specialists*

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

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

33. Emergency Department Visits by Region(2005) Northern Lights Diabetes Average = 1.4

35. Diabetes & CVDAcute Coronary Syndrome, 1995-2005

36. Diabetes & CVDAcute Coronary Syndrome, 1995-2005

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

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

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

41. 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

42. Key Findings and Policy Options: Eye Disease KEY FINDING POLICY OPTIONS • 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. 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.

44. Crude ESRD by Region (2005)

45. Prevalent ESRD Cases by Region (2005)

46. Kidney TransplantationProportion of DM vs. no DM

47. Diabetes and Special Populations

48. Diabetes and First Nations Diabetes Prevalence Rate=8.3%

49. Age-Specific Diabetes Prevalence among First Nations, 2005 Diabetes Prevalence (%) Age Group (Years)

50. Alberta Diabetes Atlas 2007 Other topics included: DM & Lower Limb Amputation DM & Mental Health • Affective disorders • Anxiety disorders • Psychoses (organic & non-organic) • Substance abuse disorders