The National Diabetes
Management Strategy:
Diabetes Facts and Figures
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Diabetes is a
Worldwide Problem
Diabetes is a Worldwide Epidemic
In 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%)
2011
2030
Total world population (billions)
7.0
8.3
Adult population (20–79 years, billions)
4.4
5.6
Global prevalence (%)
8.3
9.9
Number of people with diabetes (millions)
366
552
Diabetes
International Diabetes Federation. IDF Diabetes Atlas. Update 2012.
International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5th edition 2011.
Global Diabetes Statistics
• Since 1980, the number of adults with diabetes
worldwide has doubled. (1)
• There will be an estimated 70% increase in the
number of adults with diabetes in the developing
world, and a 20% increase in the developed
world between 2010 and 2030. (2)
• Each year, approximately 78,000 children
worldwide 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. 5th Edition. 2011
Number of People with Diabetes:
Top 10 Countries
2011
Country/territory
2030
Country/territory
China
Number of people
with diabetes
(millions)
90.0
China
Number of people
with diabetes
(millions)
129.7
India
61.3
India
101.2
USA
23.7
USA
29.6
Russian Federation
12.6
Brazil
19.6
Brazil
12.4
Bangladesh
16.8
Japan
10.7
Mexico
16.4
Mexico
10.3
Russian Federation
14.1
Bangladesh
8.4
Egypt
12.4
Egypt
7.3
Indonesia
11.8
Indonesia
7.3
Pakistan
11.4
International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5th edition 2011.
Prevalence of Diabetes:
Top 10 Countries
2011
Country/territory
2030
Country/territory
Kiribati
Prevalence of
diabetes (%)
25.7
Kiribati
Prevalence of
diabetes (%)
26.3
Marshall Islands
22.2
Marshall Islands
23.0
Kuwait
21.1
Kuwait
21.2
Nauru
20.7
Tuvalu
20.8
Lebanon
20.2
Nauru
20.7
Qatar
20.2
Saudi Arabia
20.6
Saudi Arabia
20.0
Lebanon
20.4
Bahrain
19.9
Qatar
20.4
Tuvalu
19.5
Bahrain
20.2
United Arab
Emirates
19.2
United Arab
Emirates
19.8
International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5th edition 2011.
Leading Causes of Global Death:
2004 and 2030
Chronic conditions have overtaken infectious diseases
as the leading causes of global death.
2004
Disease
2030
Deaths
Rank
Rank
Deaths
Heart disease
12.2
1
1
14.2
CVD
9.7
2
2
12.1
Pneumonia
7.0
3
4
3.8
HIV/AIDS
3.5
6
10
1.8
Lung cancer
2.3
8
6
3.4
Diabetes
1.9
12
7
3.3
Malaria
1.7
13
41
0.4
Breast cancer
0.9
23
19
1.1
World Health Statistics. World Health Organization; 2008.
US Diabetes Statistics
• 25.8 million Americans (8.3% of the US
population) have diabetes:
– Diagnosed: 18.8 million people
– Undiagnosed: 7.0 million people
– Prediabetes: 79 million people
• One in every 400 American children is currently
diagnosed with diabetes.
National Diabetes Fact Sheet 2011. Centers for Disease Control and Prevention.
Diabetes is a
Canadian Problem
Diabetes is the Sixth Leading
Cause of Death in Canada
Cause of death
Rank
Number
−
226,584
Cancer
1
66,947
Heart diseases
2
52,000
Stroke
Chronic lower respiratory
diseases
3
14,626
4
10,041
Accidents (unintentional injuries)
5
8,986
Diabetes
6
7,823
Influenza and pneumonia
7
5,729
Alzheimer’s disease
8
5,536
Suicide
9
3,613
Kidney diseases
10
3,541
All other causes
−
47,742
All causes of death
Statistics Canada. Leading causes of death in Canada, 2000 to 2004.
Canada has one of the highest prevalence of
diabetes 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, the
ranking 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 between
nations.
Source: Prevalence of diabetes in OECD countries, 2010. Available at http://www.ecosante.fr/OCDEENG/68.html Accessed June 21, 2011
Canada Has a Chronic Disease
Surveillance System
•
•
The Canadian Chronic Disease Surveillance System (CCDSS) uses
population-based administrative data from every province and territory. In
each province and territory, the health insurance registry database is linked
to 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 or
older at time of diabetes diagnosis from all provinces and territories from
1995/96 to 2008/09
Age-standardized data are adjusted to 1991 Census data
Can’t distinguish between type 1 and type 2
Validated methodology
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public
Health Perspective. Ottawa, ON: 2011.
Prevalence of Diagnosed Diabetes
The prevalence of diagnosed diabetes in Canada in 2008–2009
was 6.8% (approximately 2.4 million people aged 1 year or older).
• 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%
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public
Health Perspective. Ottawa, ON: 2011.
Diabetes Prevalence Increases
With Age
• Prevalence increase with age and sharply
increases 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 Public
Health Perspective. Ottawa, ON: 2011.
Increase in Prevalence of
Diagnosed Diabetes
• After adjusting for differences in age distributions
among the provinces between 1998/99 and
2008/09, the prevalence of diabetes:
• increased by 70%
• was higher in men than women
• Increased in every age category
• The prevalence of diabetes in Canada is
expected to increase 3.7 million by 2018/19
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public
Health Perspective. Ottawa, ON: 2011.
Prevalence of Diagnosed Diabetes
Varies by Province
Province/territory
Newfoundland and Labrador
Nova Scotia
Ontario
New Brunswick
Manitoba
Prince Edward Island
Northwest Territories
Saskatchewan
British Columbia
Yukon
Quebec
Alberta
Nunavut
Prevalence
6.5
6.1
6.0
5.9
5.9
5.6
5.5
5.4
5.4
5.4
5.1
4.9
4.4
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
Implications of Variable Provincial
Diabetes 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
The Incidence of Diabetes in
Canada is Increasing
• The overall incidence of diabetes in 2008/09 was 6.3 per
1000 people (or 203,018 Canadians).
• Among people aged 1 year or older, 203,018 individuals
were 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 trend
as prevalence with rates that rise steeply after age 45
and peak among those aged 70–74 for both men and
women.
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public
Health Perspective. Ottawa, ON: 2011.
Diabetes in Canada: 2007 to 2017
• Between 2007 and 2017, an estimated 1.9
million Canadians (aged 20 years and older) will
be newly diagnosed with diabetes.
• This means that about nine out of every 100
Canadians are predicted to be newly diagnosed
with diabetes during the 10-year period.
Manuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.
Diabetes in Ontario
• In Ontario from 1995 to 2005, the number of adults with
diabetes increased by 113%, while the population grew
by only 17%.1
• The prevalence of diabetes is increasing in Ontario at a
rate of approximately 6% per year.1
• There are currently an estimated 1.2 million people
(8.2% of the population) diagnosed with diabetes in
Ontario.2
• This is projected to increase to more than 1.9 million
people (11.9% of the population) by 2020.2
Lipscombe 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-costmodel-released-in-ontario/
Incidence of Diabetes in Ontario
• Factors that may have affected prevalence in
Ontario from 1995–2005:
– Longevity: People with and without
diabetes are living longer: 25%
reduction in standardized mortality
from 1995 to 2005.
– Obesity: In Canada alone, rates have increased by
20 to 30% in the last decade. WHO diabetes
prevalence estimates were based on the unwarranted
assumption that obesity rates would remain constant.
Lipscombe LL, Hux JE. Lancet. 2007;369:750-756.
Incidence of Diabetes in Ontario
(cont’d)
• Other factors that may have affected prevalence in
Ontario from 1995–2005:
– Immigration: Ontario had a 51% increase
in immigrants from South Asia from 1995
to 2001.
– Incidence: Record rise of 31% from 1997
to 2003.
– Guidelines: Publication of diabetes
guidelines may have enhanced
screening and detection rates.
• The implications ... The size of the diabetes
epidemic is far greater than was anticipated.
Lipscombe LL, Hux JE. Lancet. 2007;369:750–756.
Factors Affecting the
Prevalence and Incidence of
Diabetes in Canada
An Aging Population
• The prevalence of diabetes begins to increase
steadily after age 40.
• The proportion of senior citizens in Canada’s overall
population is increasing.1
– In 2006, seniors accounted for 13.7% of the total
population.2
– By 2031, seniors will account for approximately 24%
(almost double 2006 levels).2
1. 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.
An Aging Population (cont’d)
• By the year 2056, the median age of Canadians
will be 45–50 years.1
• Guidelines recommend screening starting at age
40. Therefore… over half the population will
have at least one risk factor (age >40) and
should be regularly screened for diabetes.2
1. Statistics Canada. 2006 Census: Age and Sex.
2. Canadian Diabetes Association Clinical Practices Guidelines Expert Committee. Can J
Diabetes. 2008;32(suppl 1) :S1–S201.
An Aging Population (cont’d)
• Aging trends vary by province, with important
implications for regional healthcare planning and
policy.
• Proportion of seniors according to the 2006
Census:
– National average: 13.5%
– Saskatchewan: 15.4% (highest)
– Alberta: 10.7% (lowest)
Statistics Canada. 2006 Census: Age and Sex.
Increasing Immigration From
High-risk Populations
• Most recent immigrants come from
populations at high risk for developing
diabetes
• Of immigrants who came to Canada from 2001–
2006, approximately 80% were from populations
at increased risk of developing diabetes:
– 58.3% came from Asia
– 10.6% came from Africa
– 10.8% came from Central/South America and
the Caribbean
Statistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration.
Implications of Immigration Patterns for
Diabetes Prevalence and Incidence
• Healthcare system will need to respond to the
specific healthcare needs of these populations
with culturally and linguistically relevant
prevention, screening and management
practices.
• Major cities (Toronto, Vancouver, Montreal) are
home to the majority of recent immigrants (69%),
with implications for local healthcare planning.
Statistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration.
Percentage of Foreign-born Canadians
is Increasing
• By 2031, between 25% and 28% of
the population could be foreign-born.
• Between 29% and 32% of the
population could belong to a visible
minority group, as defined in the
Employment Equity Act.
• This would be nearly double the
proportion reported by the 2006
Census.
Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.
The Percentage of Foreign-born
Canadians Is Increasing (cont’d)
• About 55% of this population would
be born in Asian countries, which
have a very high incidence and
prevalence of type 2 diabetes.
• In addition, Canada’s Black and
Filipino populations could double,
and Arab and West Asian groups
could more than triple.
Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.
Increasing Prevalence of Adult
and 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 among
55 to 64 year olds
– 24% of men
– 21% of women1
• In boys and girls aged 2–17 years, prevalence of obesity
from 1978/1979 to 2004 increased from 3% to 8%.2
1. Statistics Canada. Canadian Community Health Survey, 2008.
2. Lau DCW, et al. CMAJ. 2007;176(8 Suppl):S1–13.
Overweight, Obesity and Diabetes
• Between 2007 and 2017, it is estimated that
people who are overweight (BMI 25–30 kg/m2)
will comprise the greatest number of new cases
of diabetes (712,000)
• While those who are overweight have lower
baseline risk than those who are obese (BMI
30–35 kg/m2) or morbidly obese (BMI >35
kg/m2), there are more more Canadians who are
overweight than obese
Manuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.
Low Levels of Physical Activity
• In 2008, only 51% of Canadians reported being
at least moderately active during their leisure
time.
• “Moderately active” is equivalent to walking at
least 30 minutes a day or taking an hour-long
exercise class at least 3 times a week.
Statistics Canada. Canadian Community Health Survey, 2008.
Socioeconomic & Environmental Impact on Health:
Canadians Living in Poverty
• Health follows a social gradient: populations in a lower position
in 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 in
poverty
• Compared to those in the highest-income neighbourhoods, life
expectancy in the lowest-income quintile neighbourhoods in
Canada is:
– 5 years shorter for men
– 1.6 years shorter for women2
1.
2.
Canada’s Record on Poverty Among The Worst of Developed
Countries−And Slipping. Available at: http://www.conferenceboard.ca.
Ontario Medical Review. 2008;May:32-37.
Socioeconomic & Environmental Factors
Diabetes 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 diabetes
prevalence rate was highest among adults with a
household income of <$20,000 (8%)
• This rate was double that of the group with an income of
$60,000 (4%).2
1. 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.
Socioeconomic & Environmental Factors
Diabetes Disproportionately Affects the Poor
• People in lower income brackets and with fewer years of
education also report the following (all of which are risk
factors for diabetes):
– Higher rates of smoking
– Less physical activity; and
– Higher rates of overweight
Statistics Canada. National Population Health Survey – Household Component Longitudinal, 1998–1999.
Socioeconomic & Environmental Factors
Diabetes Disproportionately Affects the Poor
• The poor are disproportionately affected by some
diabetes risk factors.
• Some risk factors for type 2 diabetes are more common
among Canadians in the lowest income quintiles
compared with those in the highest income quintiles.
These include:
– physical inactivity
– inadequate fruit and vegetable consumption
– daily smoking
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public
Health Perspective. Ottawa, ON: 2011.
Socioeconomic Status Also Affects
Diabetes Care
• In 2007, people with higher household incomes were
more 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 diabetes
receiving 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.
Diabetes is an Aboriginal
Problem
Diabetes is an Epidemic in
Aboriginal Populations
• The national age-adjusted prevalence is 2.5 to 5
times 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 2
diabetes at a much younger age, with high rates
of 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.
Aboriginals are Disproportionately
Affected by Diabetes
Self-reported diabetes among Aboriginal and First Nations populations is
higher than in the non-Aboriginal populations.
Population
Data source
Age of
surveyed
population
Prevalence (%)
(95% confidence interval)
Crude
NonAboriginal
First Nations
(on-reserve)
First Nations
(off-reserve)
Inuit
Métis
2009-10
CCHS
2008-2010
RHS
2009-10
CCHS
2006
APS
2009-10
CCHS
12+
18+
12+
15+
12+
6.0
(5.8-6.3)
15.3
(14.2-61.4)
8.7
(7.0-10.4)
4
(3.3-5.6)
5.8
(4.4-7.3)
Agestandardized
5.0
(4.3-5.7)
17.2
(16.5-19.0)
10.3
(3.4-17.2)
NA
7.3
(2.2-12.5)
APS = Aboriginal Peoples Survey; CCHS = Canadian Community Health Survey; RHS = First Nations Regional Longitudinal Health Survey
Younger Age of Diagnosis Among
First Nations Peoples
Compared with the general population of people with
type 2 diabetes, First Nations peoples were
diagnosed with diabetes on average a decade earlier.
General population
with type 2 diabetes
in family practice
setting
(2003-2003) (1)
General population
with type 2 diabetes
in family practice
setting
(2005-2006) (2)
First Nations
population with type
2 diabetes in 19
communities
(2007)(3)
54.9 years
55 years
43.7 years
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.
Higher Rates of Complications in First
Nations Peoples With Diabetes
Compared with the general population with type 2 diabetes, First Nations peoples with
diabetes 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 First
Nations than in the general population with type 2 diabetes.
Complication
1.
2.
First Nations
General population with
population with type 2 type 2 diabetes in family
diabetes in 19
practice setting (2002communities (2007) 1)
2003) (2)
Age at audit
54.9
62.7
Chronic kidney disease
55.1
6.0
Depression
21.1
14
Neuropathy
10.8
8.0
Retinopathy
10.7
7.0
Diabetic foot disease
5.5
2.0
Number of diabetes-related health visits
8.7
4.3
Harris SB, et al. Diabetes Res Clin Pract. 2011;92(2):272-279.
Harris S, et al. Diabetes Res Clin Pract. 2005;70(1):90-97.
High Rates of GDM in Aboriginal
Women
Gestational diabetes mellitus (GDM) is defined as
diabetes with onset or first recognition during pregnancy.
It is a risk factor for later development of type 2 diabetes
in the mother, as well as in the offspring.
Population
Non-Aboriginal
First Nations
Inuit
Métis
Prevalence (%)
0.5
4.8
4.0
2.2
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
Increased Prevalence of Diabetes in
Pregnancy and Adverse Outcomes
• Compared to non-FN women, FN women onreserve 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, neonatal
hypoglycemia, shoulder dystocia
– Less primary care after birth
Liu S, et al. Diabetic Med. 2012: [Epub ahead of print]
Aboriginal Population Growth
• Type 2 diabetes has reached epidemic proportions among
Canadian Aboriginal peoples.
• The national age-adjusted prevalence is 2.5 to 5 times higher
than that of the general population, and age-adjusted
prevalence rates as high as 26% have been found in
individual communities.1-3
• Aboriginal peoples are diagnosed with type 2 diabetes at a
much younger age, with high rates of diabetes in children and
adolescents.4
• Due primarily to a high birth rate, from 1996 to 2003, the
Aboriginal population grew by 45%, nearly 6 times the growth
rate of non-Aboriginals.5
1. Dyck R, et al. CMAJ. 2010; 182(3):249-256.
4. Fagot-Campagna A, et al. J Pediatr. 2000;136:664–672.
2. Green C, et al. Diabetes Care. 2003;26:1993–1998. 5. Statistics Canada. Aboriginal population in 2017.
3. Harris SB, et al. Diabetes Care. 1997;20:185–187.
Diabetes Surveillance System for
First Nations Communities
• The First Nations Diabetes Surveillance System is a
web-based surveillance application that will track type
2 diabetes and complication rates over time in First
Nations communities.
• This information will allow the monitoring of the diabetes
burden in each partnering community and can be used
to inform and evaluate new quality improvement
initiatives in communities.
• The goal of the Surveillance System is to monitor and
track diabetes rates so that informed decisions can be
made to improve community care.
First Nations Surveillance System Newsletter. November 2010.
Diabetes Surveillance System for
First Nations Communities
• Similar programs in Aboriginal settings in the United
States and Australia have been associated with
sustained improvements in quality of care for people
diagnosed with diabetes.
• Although this program is currently a 2-year pilot program,
it is hoped that in the future the system will be expanded
to include other communities, and that ongoing financial
support will help sustain the program.
• The Surveillance System has been generously funded
by the Aboriginal Diabetes Initiative, First Nations and
Inuit Health Branch at Health Canada.
First Nations Surveillance System Newsletter. November 2010.
Diabetes is a Serious Disease
Diabetes is Associated with
Serious 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 or
cerebrovascular event
– Have a 2- to 3-fold increased risk of CAD
Public 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.
Diabetes is the Leading Cause
of End-stage Renal Disease
• Diabetes and ESRD in Canada (2010)
– Diabetes was the leading cause of ESRD, identified in
35% of new cases.
– The average age of incident hemodialysis patients was
65.3
• More than half of these patients reported having diabetes.
– Between 2001 and 2010, the prevalence rate of ESRD
patients with diabetes as a primary diagnosis increased by
54%.
– The lowest five-year survival rates in patients receiving
dialysis 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.
Diabetes is Associated with Higher
Mortality After Cancer Surgery
• People with diabetes who undergo cancer surgery are more
likely to die in the month following their operation than people
who have cancer, but do not have diabetes.
• People with newly diagnosed cancers – especially colorectal
or esophageal tumours – who also have type 2 diabetes have
an approximately 50% greater risk of dying following surgery.
• While the reasons for this are not clear, possible explanations
include:
– increased risk of infection and infection-related mortality
associated with diabetes
– increased risk of cardiovascular death associated with diabetes.
Barone BB, et al. Diabetes Care. 2010;33:931-939.
Diabetes is a Strain on Out-patient
and In-patient Resources
• Compared to people without diabetes, adults with
diabetes 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 with
diabetes 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 increase
Public Health Agency of Canada. Report from the National Diabetes Surveillance: Diabetes in Canada 2009.
Diabetes Shortens Life Expectancy
For All Ages
• A 50-year-old with diabetes dies, on average, 6
years earlier than a counterpart without
diabetes
• Compared to people without diabetes, people
with diabetes have higher mortality rates:
– 20–44 years: 4 to 6 times higher
– 45–79 years: 2 to 3 times higher
The Emerging Risk Factors Collaboration. N Engl J Med 2011; 364:829-841
Public Health Agency of Canada. Report from the National Diabetes Surveillance: Diabetes in Canada 2009.
Diabetes Shortens Life Expectancy
For All Ages
• Compared to people without diabetes, people
with diabetes have higher mortality rates:
– 20–44 years: 4 to 6 times higher
– 45–79 years: 2 to 3 times higher
Public Health Agency of Canada. Report from the National Diabetes Surveillance: Diabetes in Canada 2009.
Diabetes is a Frequent Reason for Physician
Visits
Top 10 reasons* for patient visits¶ to physicians in Canada, 2010
1. Hypertension
2. 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. Depression
5. Anxiety
6. Acute upper respiratory infection
7. Normal pregnancy supervision
8. Hyperlipidemia
9. Esophagitis
10. Hypothyroidism
* Based on ICD-9 classifications. ¶ Visits made to Canadian office-based physicians – physicians maintaining an office outside
hospitals
Diabetes Treatments are Among the Top 10 Most
Frequently Dispensed Therapeutic
Classes in Canada
Rank
Therapeutic class
Prescriptions* dispensed
in 2010 (in millions)
1
Cardiovasculars
77,130
2
Psychotherapeutics
64,853
3
Gastrointestinal/genitourinary
36,283
4
Cholesterol agents
34,214
5
Hormones
26,650
6
Analgesics
25,232
7
Anti-infectives (systemic)
24,532
8
Diabetes therapies
21,348
9
Neurological disorders
22,773
10
Diuretics
17,835
*Estimated prescriptions dispensed in Canadian retail pharmacies. Includes new and refills
IMS Brogan; CompuScript, 2010.
Diabetes Treatments are Among the Top 10
Therapeutic Classes by Worldwide Sales, 2011
Rank
Therapeutic class
Sales
(US$ billions)
% Sales
growth
1
Oncologics
62.2
5.5
2
Respiratory agents
39.4
7.3
3
Anti-diabetics
39.2
11.4
4
Lipid regulators
38.7
3.7
5
Anti-psychotics
28.4
9.4
6
Angiotensin-II antagonists
27.4
-0.7
7
Anti-ulcerants
26.9
-6.4
8
Autoimmune agents
24.4
14.1
9
Anti-depressants
20.4
-1.5
10
HIV antivirals
17.4
9.5
Sales cover direct and indirect pharmaceutical channel purchases in US dollars from pharmaceutical wholesalers
and manufacturers. The figures above include prescription and certain over-the-counter data and represent
manufacturer prices. Totals may not add up to 100% due to rounding.
IMS Health, MIDAS, December 2011
Worldwide, diabetic retinopathy is responsible for
4.8% of cases of blindness due to eye disease
• Diabetic retinopathy is responsible for 4.8% of the 37
million cases of blindness due to eye diseases
throughout the world (i.e. 1.8 million persons).
• After 15 years of having diabetes, about 2.0% of
individuals will become blind, while about 10% will suffer
severe visual loss.
• After 20 years, over 75% of people with diabetes will
have some form of diabetic retinopathy.
• This eye disease can seriously compromise people's
ability to work and live productive lives.
VISION 20/20 The Right to Sight. Diabetic Retinopathy.
Diabetes is an
Expensive Disease
Diabetes is Straining Worldwide
Healthcare Budgets
• In 2012, the estimated global healthcare cost to
diagnose and treat diabetes is at least $471
billion USD.
International Diabetes Federation. Diabetes Atlas Update 2012.
Diabetes is Straining Canadian
Healthcare 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 account
for approximately 3.5% of public healthcare
spending.
Canadian Diabetes Association. An Economic Tsunami, The Cost Of Diabetes. 2009
Healthcare Costs for Diabetes Will
Increase
• As the general population ages, the prevalence
of diabetes and the associated costs are
expected to increase.
• As the population with diabetes ages, there will
be an increase in long-term complications (e.g.
cardiovascular disease, kidney disease) and
associated costs to treat these complications
(e.g. hospitalizations, dialysis).
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures
from a Public Health Perspective. Ottawa, ON: 2011.
Diabetes is Straining American
Healthcare Budgets
• In 2012, the total estimated cost of diagnosed
diabetes was $245 billion – $176 billion in direct
medical costs and $69 billion in reduced
productivity.
• People with diagnosed diabetes have medical
expenditures that are about 2.3 times higher
than they would be in the absence of diabetes.
• More than 1 in 5 healthcare dollars in the US is
spent on people with diabetes.
American Diabetes Association. Economic costs of diabetes in the U.S. in
2012. Diabetes Care. Ahead of print, March 6, 2013.
Diabetes Management in
Canada
CDA Publishes Clinical Practice
Guidelines
• The Canadian Diabetes Association Clinical
Practice Guidelines for the Prevention and
Management of Diabetes in Canada are
published once every 5 years (most recently in
2008)
• Represent the best and most current evidencebased clinical practice data for healthcare
professionals
Many Patients Not Meeting
Therapeutic Targets
• The goal of treatment is to minimize the risk of
complications by aiming for guideline-recommended
targets.
• Studies of Canadian patients with type 2 diabetes in the
primary 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 CDA
guideline-recommended target). In the 2008 CDA guidelines, this
target was lowered to 2.0 mmol/L. Had this target been applied,
63% would have been above target2
– Only 21% achieved all three key targets1
1. 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.
Public Awareness About
Diabetes is Low
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 than
breast 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.
American Diabetes Association
Awareness Survey
•
The American Diabetes Association conducted an online survey to determine
what 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, while
fewer (6%) have been diagnosed with cancer.
Further, cancer and diabetes have similar rates of expected new cases
each year
American Diabetes Association Survey.