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The National DiabetesManagement Strategy:Diabetes Facts and FiguresBy using these slides, you agree to theterms on the nex...
Terms of Use• By using this web site and/or these slides and/or requesting and receiving the information on thissite, you ...
Diabetes is aWorldwide Problem
Diabetes is a Worldwide Epidemic2011 2030Total world population (billions) 7.0 8.3Adult population (20–79 years, billions)...
Global Diabetes Statistics• Since 1980, the number of adults with diabetesworldwide has doubled. (1)• There will be an est...
Number of People with Diabetes:Top 10 Countries2011 2030Country/territory Number of peoplewith diabetes(millions)Country/t...
Prevalence of Diabetes:Top 10 Countries2011 2030Country/territory Prevalence ofdiabetes (%)Country/territory Prevalence of...
Leading Causes of Global Death:2004 and 20302004 2030Disease Deaths Rank Rank DeathsHeart disease 12.2 1 1 14.2CVD 9.7 2 2...
US Diabetes Statistics• 25.8 million Americans (8.3% of the USpopulation) have diabetes:– Diagnosed: 18.8 million people– ...
Diabetes is aCanadian Problem
Diabetes is the Sixth LeadingCause of Death in CanadaCause of death Rank NumberAll causes of death − 226,584Cancer 1 66,94...
Canada has one of the highest prevalence ofdiabetes amongst OECD member countries* Although there are 30 OECD member count...
Canada Has a Chronic DiseaseSurveillance System• The Canadian Chronic Disease Surveillance System (CCDSS) usespopulation-b...
Prevalence of Diagnosed Diabetes• Overall prevalence: 6.8% (N=2,359,252)– Males: 7.2% (n=1,238,826)– Females: 6.4% (n=1,12...
Diabetes Prevalence IncreasesWith Age• Prevalence increase with age and sharplyincreases in middle age:– 35-39 years: 2.6%...
Increase in Prevalence ofDiagnosed Diabetes• After adjusting for differences in age distributionsamong the provinces betwe...
Prevalence of Diagnosed DiabetesVaries by ProvinceProvince/territory PrevalenceNewfoundland and Labrador 6.5Nova Scotia 6....
Implications of Variable ProvincialDiabetes Prevalence Rates• Implications for provincially specific:– human and financial...
The Incidence of Diabetes inCanada is Increasing• The overall incidence of diabetes in 2008/09 was 6.3 per1000 people (or ...
Diabetes in Canada: 2007 to 2017• Between 2007 and 2017, an estimated 1.9million Canadians (aged 20 years and older) willb...
Diabetes in Ontario• In Ontario from 1995 to 2005, the number of adults withdiabetes increased by 113%, while the populati...
Incidence of Diabetes in Ontario• Factors that may have affected prevalence inOntario from 1995–2005:– Longevity: People w...
Incidence of Diabetes in Ontario(cont’d)• Other factors that may have affected prevalence inOntario from 1995–2005:– Immig...
Factors Affecting thePrevalence and Incidence ofDiabetes in Canada
An Aging Population• The prevalence of diabetes begins to increasesteadily after age 40.• The proportion of senior citizen...
An Aging Population (cont’d)• By the year 2056, the median age of Canadianswill be 45–50 years.1• Guidelines recommend scr...
An Aging Population (cont’d)• Aging trends vary by province, with importantimplications for regional healthcare planning a...
Increasing Immigration FromHigh-risk Populations• Most recent immigrants come frompopulations at high risk for developingd...
Implications of Immigration Patterns forDiabetes Prevalence and Incidence• Healthcare system will need to respond to thesp...
Percentage of Foreign-born Canadiansis Increasing• By 2031, between 25% and 28% ofthe population could be foreign-born.• B...
The Percentage of Foreign-bornCanadians Is Increasing (cont’d)• About 55% of this population wouldbe born in Asian countri...
Increasing Prevalence of Adultand Childhood Obesity• In 2008, of adult Canadians:– 51% being overweight– 17% reported bein...
Overweight, Obesity and Diabetes• Between 2007 and 2017, it is estimated thatpeople who are overweight (BMI 25–30 kg/m2)wi...
Low Levels of Physical Activity• In 2008, only 51% of Canadians reported beingat least moderately active during their leis...
Socioeconomic & Environmental Impact on Health:Canadians Living in Poverty• Health follows a social gradient: populations ...
Socioeconomic & Environmental FactorsDiabetes Disproportionately Affects the Poor• Diabetes is disproportionately clustere...
Socioeconomic & Environmental FactorsDiabetes Disproportionately Affects the Poor• People in lower income brackets and wit...
Socioeconomic & Environmental FactorsDiabetes Disproportionately Affects the Poor• The poor are disproportionately affecte...
Socioeconomic Status Also AffectsDiabetes Care• In 2007, people with higher household incomes weremore likely to receive:–...
Diabetes is an AboriginalProblem
Diabetes is an Epidemic inAboriginal Populations• The national age-adjusted prevalence is 2.5 to 5times higher than that o...
Aboriginals are DisproportionatelyAffected by DiabetesPopulation Data source Age ofsurveyedpopulationPrevalence (%)(95% co...
Younger Age of Diagnosis AmongFirst Nations PeoplesGeneral populationwith type 2 diabetesin family practicesetting(2003-20...
Higher Rates of Complications in FirstNations Peoples With DiabetesComplication First Nationspopulation with type 2diabete...
High Rates of GDM in AboriginalWomenPopulation Prevalence (%)Non-Aboriginal 0.5First Nations 4.8Inuit 4.0Métis 2.2Gestatio...
Increased Prevalence of Diabetes inPregnancy and Adverse OutcomesLiu S, et al. Diabetic Med. 2012: [Epub ahead of print]• ...
Aboriginal Population Growth• Type 2 diabetes has reached epidemic proportions amongCanadian Aboriginal peoples.• The nati...
Diabetes Surveillance System forFirst Nations Communities• The First Nations Diabetes Surveillance System is aweb-based su...
Diabetes Surveillance System forFirst Nations Communities• Similar programs in Aboriginal settings in the UnitedStates and...
Diabetes is a Serious Disease
Diabetes is Associated withSerious Complications• Diabetes is associated with significant morbidity• Among people with dia...
Diabetes is the Leading Causeof End-stage Renal Disease• Diabetes and ESRD in Canada (2010)– Diabetes was the leading caus...
Diabetes is Associated with HigherMortality After Cancer Surgery• People with diabetes who undergo cancer surgery are more...
Diabetes is a Strain on Out-patientand In-patient Resources• Compared to people without diabetes, adults withdiabetes in C...
Diabetes Shortens Life ExpectancyFor All Ages• A 50-year-old with diabetes dies, on average, 6years earlier than a counter...
Diabetes Shortens Life ExpectancyFor All Ages• Compared to people without diabetes, peoplewith diabetes have higher mortal...
Diabetes is a Frequent Reason forPhysician VisitsTop 10 reasons* for patient visits¶to physicians in Canada, 20101. Hypert...
Diabetes Treatments are Among the Top 10 MostFrequently Dispensed TherapeuticClasses in CanadaRank Therapeutic classPrescr...
Diabetes Treatments are Among the Top 10Therapeutic Classes by Worldwide Sales, 2011IMS Health, MIDAS, December 2011Rank T...
Worldwide, diabetic retinopathy is responsible for4.8% of cases of blindness due to eye disease• Diabetic retinopathy is r...
Diabetes is anExpensive Disease
Diabetes is Straining WorldwideHealthcare Budgets• In 2012, the estimated global healthcare cost todiagnose and treat diab...
Diabetes is Straining CanadianHealthcare Budgets• The economic burden of diabetes in Canada is:– currently estimated to be...
Healthcare Costs for Diabetes WillIncrease• As the general population ages, the prevalenceof diabetes and the associated c...
Diabetes is Straining AmericanHealthcare Budgets• In 2012, the total estimated cost of diagnoseddiabetes was $245 billion ...
Diabetes Management inCanada
CDA Publishes Clinical PracticeGuidelines• The Canadian Diabetes Association ClinicalPractice Guidelines for the Preventio...
Many Patients Not MeetingTherapeutic Targets• The goal of treatment is to minimize the risk ofcomplications by aiming for ...
Public Awareness AboutDiabetes is Low
Diabetes Awareness in the US• In the US, when asked to rank which disease (diabetes,breast cancer, AIDS) caused the most d...
American Diabetes AssociationAwareness Survey• The American Diabetes Association conducted an online survey to determinewh...
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Diabetes facts all

  1. 1. The National DiabetesManagement Strategy:Diabetes Facts and FiguresBy using these slides, you agree to theterms on the next slide.The development of these slides was made possiblethrough financial support by Mahboob ali khan .
  2. 2. Terms of Use• By using this web site and/or these slides and/or requesting and receiving the information on thissite, you are accepting these terms of use.• These slides and the related information on the The National Diabetes Management Strategywebsite synthesize publicly available information in a convenient format. This information isintended for use by policymakers, managers, media, planners, clinicians and researchers.• All information provided on this site and in these slides is publicly available from the originalsources. All information is attributed to the original source. All information in these slides iscopyrighted by other parties. As a visitor to this site, you are granted a limited license to use theinformation contained within for non-commercial use only, provided the information is notmodified and all copyright and other proprietary notices are retained.• The National Diabetes Management Strategy and The University of Western Ontario resides inOntario, Canada and this site and any transactions which you enter into through this site aregoverned by the laws of Ontario, Canada and the federal laws of Canada applicable therein.• The faculty and staff of The National Diabetes Management Strategy The University of WesternOntario shall not be liable for any damages, claims, liabilities, costs or obligations arising from theuse or misuse of the material contained on this web site, whether such obligations arise incontract, negligence, equity or statute law. The National Diabetes Management Strategy and TheUniversity of Western Ontario do not guarantee or warrant the quality, accuracy, completeness,timeliness, appropriateness or suitability of the information provided.• Links to other sites are provided as a reference to assist you in identifying and locating otherInternet resources that may be of interest. The National Diabetes Management Strategy and TheUniversity of Western Ontario does not assume responsibility for the accuracy or appropriatenessof the information contained on other sites, nor do we endorse the viewpoints expressed on othersites.
  3. 3. Diabetes is aWorldwide Problem
  4. 4. Diabetes is a Worldwide Epidemic2011 2030Total world population (billions) 7.0 8.3Adult population (20–79 years, billions) 4.4 5.6DiabetesGlobal prevalence (%) 8.3 9.9Number of people with diabetes (millions) 366 552In 2012, there were an estimated 371 million people with diabetes.In 2011, there were an estimated 366 million people with diabetes(8.3% of the world’s population)By 2030, the prevalence is projected to rise to 522 million (9.9%)International Diabetes Federation. IDF Diabetes Atlas. Update 2012.International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5thedition 2011.
  5. 5. Global Diabetes Statistics• Since 1980, the number of adults with diabetesworldwide has doubled. (1)• There will be an estimated 70% increase in thenumber of adults with diabetes in the developingworld, and a 20% increase in the developedworld between 2010 and 2030. (2)• Each year, approximately 78,000 childrenworldwide develop type 1 diabetes. (3)1. Danaei G, et al. Lancet. 2011;378(9785):31-40.2. Shaw JE, et al. Diabetes Res Clin Pract. 2010;87:8-14.3. IDF Diabetes Atlas. 5thEdition. 2011
  6. 6. Number of People with Diabetes:Top 10 Countries2011 2030Country/territory Number of peoplewith diabetes(millions)Country/territory Number of peoplewith diabetes(millions)China 90.0 China 129.7India 61.3 India 101.2USA 23.7 USA 29.6Russian Federation 12.6 Brazil 19.6Brazil 12.4 Bangladesh 16.8Japan 10.7 Mexico 16.4Mexico 10.3 Russian Federation 14.1Bangladesh 8.4 Egypt 12.4Egypt 7.3 Indonesia 11.8Indonesia 7.3 Pakistan 11.4International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5thedition 2011.
  7. 7. Prevalence of Diabetes:Top 10 Countries2011 2030Country/territory Prevalence ofdiabetes (%)Country/territory Prevalence ofdiabetes (%)Kiribati 25.7 Kiribati 26.3Marshall Islands 22.2 Marshall Islands 23.0Kuwait 21.1 Kuwait 21.2Nauru 20.7 Tuvalu 20.8Lebanon 20.2 Nauru 20.7Qatar 20.2 Saudi Arabia 20.6Saudi Arabia 20.0 Lebanon 20.4Bahrain 19.9 Qatar 20.4Tuvalu 19.5 Bahrain 20.2United ArabEmirates19.2 United ArabEmirates19.8International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5thedition 2011.
  8. 8. Leading Causes of Global Death:2004 and 20302004 2030Disease Deaths Rank Rank DeathsHeart disease 12.2 1 1 14.2CVD 9.7 2 2 12.1Pneumonia 7.0 3 4 3.8HIV/AIDS 3.5 6 10 1.8Lung cancer 2.3 8 6 3.4Diabetes 1.9 12 7 3.3Malaria 1.7 13 41 0.4Breast cancer 0.9 23 19 1.1Chronic conditions have overtaken infectious diseasesas the leading causes of global death.World Health Statistics. World Health Organization; 2008.
  9. 9. US Diabetes Statistics• 25.8 million Americans (8.3% of the USpopulation) have diabetes:– Diagnosed: 18.8 million people– Undiagnosed: 7.0 million people– Prediabetes: 79 million people• One in every 400 American children is currentlydiagnosed with diabetes.National Diabetes Fact Sheet 2011. Centers for Disease Control and Prevention.
  10. 10. Diabetes is aCanadian Problem
  11. 11. Diabetes is the Sixth LeadingCause of Death in CanadaCause of death Rank NumberAll causes of death − 226,584Cancer 1 66,947Heart diseases 2 52,000Stroke 3 14,626Chronic lower respiratorydiseases 4 10,041Accidents (unintentional injuries) 5 8,986Diabetes 6 7,823Influenza and pneumonia 7 5,729Alzheimer’s disease 8 5,536Suicide 9 3,613Kidney diseases 10 3,541All other causes − 47,742Statistics Canada. Leading causes of death in Canada, 2000 to 2004.
  12. 12. Canada has one of the highest prevalence ofdiabetes amongst OECD member countries* Although there are 30 OECD member countries, some countries had equal age-adjusted prevalence, so in this table of selected countries, theranking ranges from only 1 to 20.** Age-standardized prevalence adjusts the national prevalence to the age profile of the world and is useful for comparing prevalence betweennations.Source: Prevalence of diabetes in OECD countries, 2010. Available at http://www.ecosante.fr/OCDEENG/68.html Accessed June 21, 2011
  13. 13. Canada Has a Chronic DiseaseSurveillance System• The Canadian Chronic Disease Surveillance System (CCDSS) usespopulation-based administrative data from every province and territory. Ineach province and territory, the health insurance registry database is linkedto physician billing and hospitalization databases• An individual is identified as having diagnosed diabetes, if:– At least one hospitalization with diagnosis of diabetes; or– At least two physician visits with a diagnosis of diabetes within a 2-year period– Gestational diabetes mellitus excluded• Current national database includes summary data on individuals 1 year orolder at time of diabetes diagnosis from all provinces and territories from1995/96 to 2008/09• Age-standardized data are adjusted to 1991 Census data• Can’t distinguish between type 1 and type 2• Validated methodologyPublic Health Agency of Canada. Diabetes in Canada: Facts and Figures from a PublicHealth Perspective. Ottawa, ON: 2011.
  14. 14. Prevalence of Diagnosed Diabetes• Overall prevalence: 6.8% (N=2,359,252)– Males: 7.2% (n=1,238,826)– Females: 6.4% (n=1,120,426)• Age standardized prevalence: 5.6%The prevalence of diagnosed diabetes in Canada in 2008–2009was 6.8% (approximately 2.4 million people aged 1 year or older).Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a PublicHealth Perspective. Ottawa, ON: 2011.
  15. 15. Diabetes Prevalence IncreasesWith Age• Prevalence increase with age and sharplyincreases in middle age:– 35-39 years: 2.6%– 50-54 years: 8.4%– 75-79 years: 25.5%Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a PublicHealth Perspective. Ottawa, ON: 2011.
  16. 16. Increase in Prevalence ofDiagnosed Diabetes• After adjusting for differences in age distributionsamong the provinces between 1998/99 and2008/09, the prevalence of diabetes:• increased by 70%• was higher in men than women• Increased in every age category• The prevalence of diabetes in Canada isexpected to increase 3.7 million by 2018/19Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a PublicHealth Perspective. Ottawa, ON: 2011.
  17. 17. Prevalence of Diagnosed DiabetesVaries by ProvinceProvince/territory PrevalenceNewfoundland and Labrador 6.5Nova Scotia 6.1Ontario 6.0New Brunswick 5.9Manitoba 5.9Prince Edward Island 5.6Northwest Territories 5.5Saskatchewan 5.4British Columbia 5.4Yukon 5.4Quebec 5.1Alberta 4.9Nunavut 4.4Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
  18. 18. Implications of Variable ProvincialDiabetes Prevalence Rates• Implications for provincially specific:– human and financial resource planning– population-based prevention strategies– individual risk factor reduction– screening for diabetes and pre-diabetes, and– management
  19. 19. The Incidence of Diabetes inCanada is Increasing• The overall incidence of diabetes in 2008/09 was 6.3 per1000 people (or 203,018 Canadians).• Among people aged 1 year or older, 203,018 individualswere given a new diagnosis of diabetes:– 6.3 per 1000 individuals– 5.7 per 1000 girls/women– 6.8 per 1000 boys/men• Rates of new diagnosis of diabetes show a similar trendas prevalence with rates that rise steeply after age 45and peak among those aged 70–74 for both men andwomen.Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a PublicHealth Perspective. Ottawa, ON: 2011.
  20. 20. Diabetes in Canada: 2007 to 2017• Between 2007 and 2017, an estimated 1.9million Canadians (aged 20 years and older) willbe newly diagnosed with diabetes.• This means that about nine out of every 100Canadians are predicted to be newly diagnosedwith diabetes during the 10-year period.Manuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.
  21. 21. Diabetes in Ontario• In Ontario from 1995 to 2005, the number of adults withdiabetes increased by 113%, while the population grewby only 17%.1• The prevalence of diabetes is increasing in Ontario at arate of approximately 6% per year.1• There are currently an estimated 1.2 million people(8.2% of the population) diagnosed with diabetes inOntario.2• This is projected to increase to more than 1.9 millionpeople (11.9% of the population) by 2020.2Lipscombe LL, Hux JE. Lancet. 2007;369:750-756.Canadian Diabetes Association. The Burden of Diabetes in Ontario.http://www.diabetes.ca/get-involved/news/diabetes-cost-model-released-in-ontario/
  22. 22. Incidence of Diabetes in Ontario• Factors that may have affected prevalence inOntario from 1995–2005:– Longevity: People with and withoutdiabetes are living longer: 25%reduction in standardized mortalityfrom 1995 to 2005.– Obesity: In Canada alone, rates have increased by20 to 30% in the last decade. WHO diabetesprevalence estimates were based on the unwarrantedassumption that obesity rates would remain constant.Lipscombe LL, Hux JE. Lancet. 2007;369:750-756.
  23. 23. Incidence of Diabetes in Ontario(cont’d)• Other factors that may have affected prevalence inOntario from 1995–2005:– Immigration: Ontario had a 51% increasein immigrants from South Asia from 1995to 2001.– Incidence: Record rise of 31% from 1997to 2003.– Guidelines: Publication of diabetesguidelines may have enhancedscreening and detection rates.• The implications ... The size of the diabetesepidemic is far greater than was anticipated.Lipscombe LL, Hux JE. Lancet. 2007;369:750–756.
  24. 24. Factors Affecting thePrevalence and Incidence ofDiabetes in Canada
  25. 25. An Aging Population• The prevalence of diabetes begins to increasesteadily after age 40.• The proportion of senior citizens in Canada’s overallpopulation is increasing.1– In 2006, seniors accounted for 13.7% of the totalpopulation.2– By 2031, seniors will account for approximately 24%(almost double 2006 levels).21. Canadian Diabetes Association Clinical Practices Guidelines Expert Committee.Can J Diabetes. 2008;32(suppl 1) :S1–S201.2. Statistics Canada. Population projections 2005–2031.3. Statistics Canada. 2006 Census: Age and Sex.
  26. 26. An Aging Population (cont’d)• By the year 2056, the median age of Canadianswill be 45–50 years.1• Guidelines recommend screening starting at age40. Therefore… over half the population willhave at least one risk factor (age >40) andshould be regularly screened for diabetes.21. Statistics Canada. 2006 Census: Age and Sex.2. Canadian Diabetes Association Clinical Practices Guidelines Expert Committee. Can JDiabetes. 2008;32(suppl 1) :S1–S201.
  27. 27. An Aging Population (cont’d)• Aging trends vary by province, with importantimplications for regional healthcare planning andpolicy.• Proportion of seniors according to the 2006Census:– National average: 13.5%– Saskatchewan: 15.4% (highest)– Alberta: 10.7% (lowest)Statistics Canada. 2006 Census: Age and Sex.
  28. 28. Increasing Immigration FromHigh-risk Populations• Most recent immigrants come frompopulations at high risk for developingdiabetes• Of immigrants who came to Canada from 2001–2006, approximately 80% were from populationsat increased risk of developing diabetes:– 58.3% came from Asia– 10.6% came from Africa– 10.8% came from Central/South America andthe CaribbeanStatistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration.
  29. 29. Implications of Immigration Patterns forDiabetes Prevalence and Incidence• Healthcare system will need to respond to thespecific healthcare needs of these populationswith culturally and linguistically relevantprevention, screening and managementpractices.• Major cities (Toronto, Vancouver, Montreal) arehome to the majority of recent immigrants(69%), with implications for local healthcareplanning.Statistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration.
  30. 30. Percentage of Foreign-born Canadiansis Increasing• By 2031, between 25% and 28% ofthe population could be foreign-born.• Between 29% and 32% of thepopulation could belong to a visibleminority group, as defined in theEmployment Equity Act.• This would be nearly double theproportion reported by the 2006Census.Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.
  31. 31. The Percentage of Foreign-bornCanadians Is Increasing (cont’d)• About 55% of this population wouldbe born in Asian countries, whichhave a very high incidence andprevalence of type 2 diabetes.• In addition, Canada’s Black andFilipino populations could double,and Arab and West Asian groupscould more than triple.Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.
  32. 32. Increasing Prevalence of Adultand Childhood Obesity• In 2008, of adult Canadians:– 51% being overweight– 17% reported being obese.1• From 2003 to 2008, obesity rates rose:– from 16% to 18% in men– from 15% to 16% in women• The highest rate of obesity (22%) was among55 to 64 year olds– 24% of men– 21% of women1• In boys and girls aged 2–17 years, prevalence of obesityfrom 1978/1979 to 2004 increased from 3% to 8%.21. Statistics Canada. Canadian Community Health Survey, 2008.2. Lau DCW, et al. CMAJ. 2007;176(8 Suppl):S1–13.
  33. 33. Overweight, Obesity and Diabetes• Between 2007 and 2017, it is estimated thatpeople who are overweight (BMI 25–30 kg/m2)will comprise the greatest number of new casesof diabetes (712,000)• While those who are overweight have lowerbaseline risk than those who are obese (BMI30–35 kg/m2) or morbidly obese (BMI >35 kg/m2),there are more more Canadians who areoverweight than obeseManuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.
  34. 34. Low Levels of Physical Activity• In 2008, only 51% of Canadians reported beingat least moderately active during their leisuretime.• “Moderately active” is equivalent to walking atleast 30 minutes a day or taking an hour-longexercise class at least 3 times a week.Statistics Canada. Canadian Community Health Survey, 2008.
  35. 35. Socioeconomic & Environmental Impact on Health:Canadians Living in Poverty• Health follows a social gradient: populations in a lower positionin the social hierarchy experience the worst health• More than 12% of the working-age population lives in poverty.1• People who live in poverty are:– often unable to meet basic housing, food and security needs– have a greater risk of health problems than people who do not live inpoverty• Compared to those in the highest-income neighbourhoods, lifeexpectancy in the lowest-income quintile neighbourhoods inCanada is:– 5 years shorter for men– 1.6 years shorter for women21. Canada’s Record on Poverty Among The Worst of DevelopedCountries−And Slipping. Available at: http://www.conferenceboard.ca.2. Ontario Medical Review. 2008;May:32-37.
  36. 36. Socioeconomic & Environmental FactorsDiabetes Disproportionately Affects the Poor• Diabetes is disproportionately clustered:1– in the lower socioeconomic status quintiles– in neighbourhoods with:• lower average household incomes• high proportions of visible minorities and/or recent immigrants• In 2007, the self-reported age-standardized diabetesprevalence rate was highest among adults with ahousehold income of <$20,000 (8%)• This rate was double that of the group with an income of≥$60,000 (4%).21. Hux JE, et al. In: Diabetes in Ontario: An ICES Practice Atlas: Institute for Clinical and Evaluative Sciences.2. Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada December 2009.
  37. 37. Socioeconomic & Environmental FactorsDiabetes Disproportionately Affects the Poor• People in lower income brackets and with fewer years ofeducation also report the following (all of which are riskfactors for diabetes):– Higher rates of smoking– Less physical activity; and– Higher rates of overweightStatistics Canada. National Population Health Survey – Household Component Longitudinal, 1998–1999.
  38. 38. Socioeconomic & Environmental FactorsDiabetes Disproportionately Affects the Poor• The poor are disproportionately affected by somediabetes risk factors.• Some risk factors for type 2 diabetes are more commonamong Canadians in the lowest income quintilescompared with those in the highest income quintiles.These include:– physical inactivity– inadequate fruit and vegetable consumption– daily smokingPublic Health Agency of Canada. Diabetes in Canada: Facts and Figures from a PublicHealth Perspective. Ottawa, ON: 2011.
  39. 39. Socioeconomic Status Also AffectsDiabetes Care• In 2007, people with higher household incomes weremore likely to receive:– an A1C test– a urine test for protein– a dilated eye exam– a foot exam– all 4 recommended tests• The age-standardized percentage of adults with diabetesreceiving all 4 recommended tests was:– highest in the highest household income group (42%)– lowest in the lowest household income group (21%)Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada; December 2009.
  40. 40. Diabetes is an AboriginalProblem
  41. 41. Diabetes is an Epidemic inAboriginal Populations• The national age-adjusted prevalence is 2.5 to 5times higher than that of the general population.• Age-adjusted prevalence rates as high as 26%have been found in individual communities.• Aboriginal peoples are diagnosed with type 2diabetes at a much younger age, with high ratesof diabetes in children and adolescents.Dyck R, et al. CMAJ. 2010; 182(3):249-256.Green C, et al. Diabetes Care. 2003;26:1993–1998.Harris SB, et al. Diabetes Care. 1997;20:185–187.Fagot-Campagna A, et al.. J Pediatr. 2000;136:664–672.
  42. 42. Aboriginals are DisproportionatelyAffected by DiabetesPopulation Data source Age ofsurveyedpopulationPrevalence (%)(95% confidence interval)Crude Age-standardizedNon-Aboriginal2009-10CCHS 12+6.0(5.8-6.3)5.0(4.3-5.7)First Nations(on-reserve)2008-2010RHS 18+15.3(14.2-61.4)17.2(16.5-19.0)First Nations(off-reserve)2009-10CCHS 12+8.7(7.0-10.4)10.3(3.4-17.2)Inuit2006APS 15+4(3.3-5.6) NAMétis2009-10CCHS 12+5.8(4.4-7.3)7.3(2.2-12.5)Self-reported diabetes among Aboriginal and First Nations populations ishigher than in the non-Aboriginal populations.APS = Aboriginal Peoples Survey; CCHS = Canadian Community Health Survey; RHS = First Nations Regional Longitudinal Health Survey
  43. 43. Younger Age of Diagnosis AmongFirst Nations PeoplesGeneral populationwith type 2 diabetesin family practicesetting(2003-2003) (1)General populationwith type 2 diabetesin family practicesetting(2005-2006) (2)First Nationspopulation with type2 diabetes in 19communities(2007)(3)54.9 years 55 years 43.7 yearsCompared with the general population of people withtype 2 diabetes, First Nations peoples werediagnosed with diabetes on average a decade earlier.1. Harris S, et al. Diabetes Res Clin Pract. 2005;70(1):90-97.2. Braga M, et al. Can J Cardiol. 2010;26(6):297-302.3 Harris SB, et al. Diabetes Res Clin Pract. 2011;92(2):272-279.
  44. 44. Higher Rates of Complications in FirstNations Peoples With DiabetesComplication First Nationspopulation with type 2diabetes in 19communities (2007) 1)General population withtype 2 diabetes in familypractice setting (2002-2003) (2)Age at audit 54.9 62.7Chronic kidney disease 55.1 6.0Depression 21.1 14Neuropathy 10.8 8.0Retinopathy 10.7 7.0Diabetic foot disease 5.5 2.0Number of diabetes-related health visits 8.7 4.3Compared with the general population with type 2 diabetes, First Nations peoples withdiabetes are younger, yet have higher rates of many of the serious complications of diabetes.This higher morbidity is reflected in double the number of diabetes-related health visits in FirstNations than in the general population with type 2 diabetes.1. Harris SB, et al. Diabetes Res Clin Pract. 2011;92(2):272-279.2. Harris S, et al. Diabetes Res Clin Pract. 2005;70(1):90-97.
  45. 45. High Rates of GDM in AboriginalWomenPopulation Prevalence (%)Non-Aboriginal 0.5First Nations 4.8Inuit 4.0Métis 2.2Gestational diabetes mellitus (GDM) is defined asdiabetes with onset or first recognition during pregnancy.It is a risk factor for later development of type 2 diabetesin the mother, as well as in the offspring.Garnier R, et al. Statistics Canada Health Analysis Division; Ottawa, ON: 2010.PHAC. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011
  46. 46. Increased Prevalence of Diabetes inPregnancy and Adverse OutcomesLiu S, et al. Diabetic Med. 2012: [Epub ahead of print]• Compared to non-FN women, FN women on-reserve in Ontario had:– Higher prevalence of diabetes in pregnancy– Less preconception/antenatal care– Less postpartum care– Higher mean birth weight and rate of macrosomia– Higher rates of pre-term delivery, jaundice, neonatalhypoglycemia, shoulder dystocia– Less primary care after birth
  47. 47. Aboriginal Population Growth• Type 2 diabetes has reached epidemic proportions amongCanadian Aboriginal peoples.• The national age-adjusted prevalence is 2.5 to 5 times higherthan that of the general population, and age-adjustedprevalence rates as high as 26% have been found inindividual communities.1-3• Aboriginal peoples are diagnosed with type 2 diabetes at amuch younger age, with high rates of diabetes in children andadolescents.4• Due primarily to a high birth rate, from 1996 to 2003, theAboriginal population grew by 45%, nearly 6 times the growthrate of non-Aboriginals.51. Dyck R, et al. CMAJ. 2010; 182(3):249-256.2. Green C, et al. Diabetes Care. 2003;26:1993–1998.3. Harris SB, et al. Diabetes Care. 1997;20:185–187.4. Fagot-Campagna A, et al. J Pediatr. 2000;136:664–672.5. Statistics Canada. Aboriginal population in 2017.
  48. 48. Diabetes Surveillance System forFirst Nations Communities• The First Nations Diabetes Surveillance System is aweb-based surveillance application that will track type2 diabetes and complication rates over time in FirstNations communities.• This information will allow the monitoring of the diabetesburden in each partnering community and can be usedto inform and evaluate new quality improvementinitiatives in communities.• The goal of the Surveillance System is to monitor andtrack diabetes rates so that informed decisions can bemade to improve community care.First Nations Surveillance System Newsletter. November 2010.
  49. 49. Diabetes Surveillance System forFirst Nations Communities• Similar programs in Aboriginal settings in the UnitedStates and Australia have been associated withsustained improvements in quality of care for peoplediagnosed with diabetes.• Although this program is currently a 2-year pilot program,it is hoped that in the future the system will be expandedto include other communities, and that ongoing financialsupport will help sustain the program.• The Surveillance System has been generously fundedby the Aboriginal Diabetes Initiative, First Nations andInuit Health Branch at Health Canada.First Nations Surveillance System Newsletter. November 2010.
  50. 50. Diabetes is a Serious Disease
  51. 51. Diabetes is Associated withSerious Complications• Diabetes is associated with significant morbidity• Among people with diabetes:– 40% have diabetic retinopathy– 15% have foot ulcers– 80–90% have obesity– 34–45% have erectile dysfunction– 40–50% have neuropathy– 40% have anxiety and 15% have depression– 75% of deaths will be due to coronary orcerebrovascular event– Have a 2- to 3-fold increased risk of CADPublic Health Agency of Canada. Diabetes in Canada: Highlights from the National Diabetes Surveillance System 2004–2005..Canadian Diabetes Association Clinical Practice Guideline Expert Committee. Can J Diabetes. 2008;32 (suppl 1): S1-S201.Statistics Canada. Sequelae of diabetes. Diabetic foot, chronic ICD-9 250.7.
  52. 52. Diabetes is the Leading Causeof End-stage Renal Disease• Diabetes and ESRD in Canada (2010)– Diabetes was the leading cause of ESRD, identified in35% of new cases.– The average age of incident hemodialysis patients was65.3• More than half of these patients reported having diabetes.– Between 2001 and 2010, the prevalence rate of ESRDpatients with diabetes as a primary diagnosis increased by54%.– The lowest five-year survival rates in patients receivingdialysis were in those with renal vascular disease (36%),drug-induced renal failure (38%), and diabetes (39%).CIHI. CORR Annual Report: Treatment of End-Stage Organ Failure in Canada: 2001-2010.
  53. 53. Diabetes is Associated with HigherMortality After Cancer Surgery• People with diabetes who undergo cancer surgery are morelikely to die in the month following their operation than peoplewho have cancer, but do not have diabetes.• People with newly diagnosed cancers – especially colorectalor esophageal tumours – who also have type 2 diabetes havean approximately 50% greater risk of dying following surgery.• While the reasons for this are not clear, possible explanationsinclude:– increased risk of infection and infection-related mortalityassociated with diabetes– increased risk of cardiovascular death associated with diabetes.Barone BB, et al. Diabetes Care. 2010;33:931-939.
  54. 54. Diabetes is a Strain on Out-patientand In-patient Resources• Compared to people without diabetes, adults withdiabetes in Canada have:– Twice as many visits to family physicians– 3 to 4 times as many visits to specialists• Compared to people without diabetes, people withdiabetes were hospitalized at higher rates for:– Heart failure: 4-fold increase– Stroke: 3-fold increase– Heart attack: 3-fold increase– Chronic kidney disease: 6-fold increase– Lower limb amputation: 19-fold increasePublic Health Agency of Canada. Report from the National Diabetes Surveillance: Diabetes in Canada 2009.
  55. 55. Diabetes Shortens Life ExpectancyFor All Ages• A 50-year-old with diabetes dies, on average, 6years earlier than a counterpart withoutdiabetes• Compared to people without diabetes, peoplewith diabetes have higher mortality rates:– 20–44 years: 4 to 6 times higher– 45–79 years: 2 to 3 times higherThe Emerging Risk Factors Collaboration. N Engl J Med 2011; 364:829-841Public Health Agency of Canada. Report from the National Diabetes Surveillance: Diabetes in Canada 2009.
  56. 56. Diabetes Shortens Life ExpectancyFor All Ages• Compared to people without diabetes, peoplewith diabetes have higher mortality rates:– 20–44 years: 4 to 6 times higher– 45–79 years: 2 to 3 times higherPublic Health Agency of Canada. Report from the National Diabetes Surveillance: Diabetes in Canada 2009.
  57. 57. Diabetes is a Frequent Reason forPhysician VisitsTop 10 reasons* for patient visits¶to physicians in Canada, 20101. Hypertension2. Diabetes (without complications)3. Health check-up(Routine Child Health Check-up [V20.2] and Routine General Medical Exam and Health Check-up[V70.0])4. Depression5. Anxiety6. Acute upper respiratory infection7. Normal pregnancy supervision8. Hyperlipidemia9. Esophagitis10. Hypothyroidism* Based on ICD-9 classifications. ¶Visits made to Canadian office-based physicians – physicians maintaining an office outsidehospitals
  58. 58. Diabetes Treatments are Among the Top 10 MostFrequently Dispensed TherapeuticClasses in CanadaRank Therapeutic classPrescriptions* dispensedin 2010 (in millions)1 Cardiovasculars 77,1302 Psychotherapeutics 64,8533 Gastrointestinal/genitourinary 36,2834 Cholesterol agents 34,2145 Hormones 26,6506 Analgesics 25,2327 Anti-infectives (systemic) 24,5328 Diabetes therapies 21,3489 Neurological disorders 22,77310 Diuretics 17,835*Estimated prescriptions dispensed in Canadian retail pharmacies. Includes new and refillsIMS Brogan; CompuScript, 2010.
  59. 59. Diabetes Treatments are Among the Top 10Therapeutic Classes by Worldwide Sales, 2011IMS Health, MIDAS, December 2011Rank Therapeutic classSales(US$ billions)% Salesgrowth1 Oncologics 62.2 5.52 Respiratory agents 39.4 7.33 Anti-diabetics 39.2 11.44 Lipid regulators 38.7 3.75 Anti-psychotics 28.4 9.46 Angiotensin-II antagonists 27.4 -0.77 Anti-ulcerants 26.9 -6.48 Autoimmune agents 24.4 14.19 Anti-depressants 20.4 -1.510 HIV antivirals 17.4 9.5Sales cover direct and indirect pharmaceutical channel purchases in US dollars from pharmaceuticalwholesalers and manufacturers. The figures above include prescription and certain over-the-counter data andrepresent manufacturer prices. Totals may not add up to 100% due to rounding.
  60. 60. Worldwide, diabetic retinopathy is responsible for4.8% of cases of blindness due to eye disease• Diabetic retinopathy is responsible for 4.8% of the 37million cases of blindness due to eye diseasesthroughout the world (i.e. 1.8 million persons).• After 15 years of having diabetes, about 2.0% ofindividuals will become blind, while about 10% will suffersevere visual loss.• After 20 years, over 75% of people with diabetes willhave some form of diabetic retinopathy.• This eye disease can seriously compromise peoplesability to work and live productive lives.VISION 20/20 The Right to Sight. Diabetic Retinopathy.
  61. 61. Diabetes is anExpensive Disease
  62. 62. Diabetes is Straining WorldwideHealthcare Budgets• In 2012, the estimated global healthcare cost todiagnose and treat diabetes is at least $471billion USD.International Diabetes Federation. Diabetes Atlas Update 2012.
  63. 63. Diabetes is Straining CanadianHealthcare Budgets• The economic burden of diabetes in Canada is:– currently estimated to be $12.2. billion– expected to increase to $16.9 billion by 2020.• The direct costs of diabetes currently accountfor approximately 3.5% of public healthcarespending.Canadian Diabetes Association. An Economic Tsunami, The Cost Of Diabetes. 2009
  64. 64. Healthcare Costs for Diabetes WillIncrease• As the general population ages, the prevalenceof diabetes and the associated costs areexpected to increase.• As the population with diabetes ages, there willbe an increase in long-term complications (e.g.cardiovascular disease, kidney disease) andassociated costs to treat these complications(e.g. hospitalizations, dialysis).Public Health Agency of Canada. Diabetes in Canada: Facts and Figuresfrom a Public Health Perspective. Ottawa, ON: 2011.
  65. 65. Diabetes is Straining AmericanHealthcare Budgets• In 2012, the total estimated cost of diagnoseddiabetes was $245 billion – $176 billion in directmedical costs and $69 billion in reducedproductivity.• People with diagnosed diabetes have medicalexpenditures that are about 2.3 times higherthan they would be in the absence of diabetes.• More than 1 in 5 healthcare dollars in the US isspent on people with diabetes.American Diabetes Association. Economic costs of diabetes in the U.S. in2012. Diabetes Care. Ahead of print, March 6, 2013.
  66. 66. Diabetes Management inCanada
  67. 67. CDA Publishes Clinical PracticeGuidelines• The Canadian Diabetes Association ClinicalPractice Guidelines for the Prevention andManagement of Diabetes in Canada arepublished once every 5 years (most recently in2008)• Represent the best and most current evidence-based clinical practice data for healthcareprofessionals
  68. 68. Many Patients Not MeetingTherapeutic Targets• The goal of treatment is to minimize the risk ofcomplications by aiming for guideline-recommendedtargets.• Studies of Canadian patients with type 2 diabetes in theprimary care setting demonstrated:– 47% to 49% were above the A1C target <7.0%1,2– 46% were above the BP target of 130/80 mm Hg2– 36% were above the LDL-C target of 2.5 mmol/L (2003 CDAguideline-recommended target). In the 2008 CDA guidelines, thistarget was lowered to 2.0 mmol/L. Had this target been applied,63% would have been above target2– Only 21% achieved all three key targets11. Braga MFB, et al. Can J Cardiol. 2010;26(6):297-302.2. Harris SB, et al. Diabetes Res Clin Prac. 2005;70(1):90-07.
  69. 69. Public Awareness AboutDiabetes is Low
  70. 70. Diabetes Awareness in the US• In the US, when asked to rank which disease (diabetes,breast cancer, AIDS) caused the most deaths each year,not even half of respondents chose diabetes (42%).• In the US, diabetes causes more deaths per year thanbreast cancer and AIDS combined.• Canadian data on diabetes awareness are not available.As America Earns Failing Grade, American Diabetes Association Launches Movement to Stop Diabetes.Available at: http://www.diabetes.org/for-media/2009/america-earns-failing-adm-sd-2009.html.
  71. 71. American Diabetes AssociationAwareness Survey• The American Diabetes Association conducted an online survey to determinewhat people fear most:– 16% feared being in a plane crash– 13% feared snake bites– 5% feared being hit by lightning– 5% feared getting an illness/disease– 4% feared a shark attack• When asked specifically about diseases:– 49% feared cancer– Only 3% cited a fear of diabetes• Ironically, 10% of adults reports having been diagnosed with diabetes, whilefewer (6%) have been diagnosed with cancer.• Further, cancer and diabetes have similar rates of expected new caseseach yearAmerican Diabetes Association Survey.

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