Jeffrey A. Johnson, PhD

1

• Jeffrey A. Johnson, PhD
• Stephanie U. Vermeulen, MSc.
• University of Alberta
• Institute of Health Economics
• March 11, 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.

8
(No Transcript)
9
(No Transcript)
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 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
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

14
(No Transcript)
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
20
Diabetes Prevalence in David Thompson(Case
Counts)
21
Prevalence Rates by Community (Age-Adjusted) 2006
22
Diabetes Prevalence (Case Counts) 2006
23
Diabetes Incidence (Case Counts) 1995-2006
24
Incidence Rates by Community (Age-Adjusted) 2006
25
Diabetes Incidence by Community (Case Counts) 2006
26
Diabetes Mortality (Age-Adjusted Rates)
27
(No Transcript)
28
Physician Visits (1995-2005)
General Practitioners
Specialists
29
Physician Visits by Region(2005)
DTHR Average 9.7
General Practitioners
DTHR Average 3.2
Specialists
30
Emergency Department Visits (Age/Sex Adjusted,
1998-2005)
31
Total Number of ED Visits for People with
Diabetes (1998-2005)
32
Emergency Department Visits by Region (2005)
DTHR Diabetes Average 1.7
33
Hospital Days(Age/Sex Adjusted, 1995-2005)
34
Hospitalization Days by Region(Age/Sex Adjusted,
2005)
DTHR Diabetes Average 2.8
35
(No Transcript)
36
Diabetes CVDAcute Coronary Syndrome, 1995-2005
37
Diabetes CVDAcute Coronary Syndrome, 1995-2005
38
Diabetes CVD Age-Adjusted Rates of Acute
Coronary Syndrome by Region, 2005
39
(No Transcript)
40
Diabetes Eye DiseaseEye Examinations,
1995-2005
Eye examinations by an Ophthalmologist
41
Diabetes Eye DiseaseEye Examinations, 2005
Eye examinations by an Ophthalmologist
42

• Diabetes and Special Populations

43
Diabetes and First Nations
Diabetes Prevalence Rate14.4
44
Under 20 Crude Diabetes Prevalence Rates by
Region, 2005
Average Provincial Rate 0.23
45
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

46
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.

47
Alberta Diabetes Fact Sheet 2008
48
ADSS - what is missing? - what is next?

• Conditions
• DM pregnancy
• DM foot disease
• DM cancer
• New data
• Laboratory surveillance
• Drug Utilization
• Risk factor surveillance

49
How YOU can use the ADSS

• ADSS can be used by the Regions to more
  accurately assess what the burden of DM and its
  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.

50
ADSS Dissemination

• 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
51
ADSS Website Search Criteria
All of Alberta Regional Health Authority Sub-Regio
n Community
Rates/Cases from 1995-2005
DM alone or DM Disease
First Nations Status
All Ages 20-34 years 35-49 years 50-64
years 65-74 years 75 years
Both Sexes Male Female
52
ADSS Health Research Potential
DM Incidence
Primary Prevention Intervention
Control No Intervention
53
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.

54
Questions???
jeff.johnson_at_ualberta.ca stephanie.vermeulen_at_ualbe
rta.ca www.ACHORD.ca