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

2.  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. Key Messages…

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. Usually occurs early in life during childhood or adolescence and is managed with insulin. Accounts for 5-10% of all diabetes cases. Type 1 Diabetes

6. 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 Type 2 Diabetes

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 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

15. Alberta Diabetes Prevalence (Age-Adjusted Rates)

16. Alberta Diabetes Prevalence (Case Counts)

17. Alberta Diabetes Incidence (Case Counts)

18. Alberta Diabetes Prevalence Age-Specific Rates, 2006

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

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) Specialists* General Practitioners Northern Lights Average =9.7 Northern Lights Average = 2.2

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 & CVD Acute Coronary Syndrome, 1995-2005

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

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

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

41. Introduction of Teleopthalmology Northern Lights Crude Rates of Eye Examination for Northern Lights, 1995-2005 Crude Rates of Retinal Laser Treatment for Northern Lights, 1995-2005

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

44. Crude ESRD by Region (2005)

45. Prevalent ESRD Cases by Region (2005)

46. Kidney Transplantation Proportion of DM vs. no DM

47. Diabetes and Special Populations

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

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

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

51. 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. Key Findings and Policy Options

52. Alberta Diabetes Fact Sheet 2008

53. Conditions:  DM & pregnancy  DM & foot disease  DM & cancer New data:  Laboratory surveillance  Drug Utilization  Risk factor surveillance What is missing? What is next?

54. ADSS can be used by the Regions to more accurately assess what the burden of DM and it’s 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. How can YOU use the ADSS?

55. 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 ADSS Dissemination

56. ADSS Website General Information about the ADSS ________________________________________________ _____________________________________________ ADSS Findings  Alberta Diabetes Atlas  Key Findings & Policy Options  Atlas Figures in PowerPoint  Diabetes Rates by AB Community (Map)  ADSS Newsletters ADSS Publications/Presentations ADSS Team ADSS on the move Funding Sources Contact Us REPORTS FROM DATABASE

57. All of Alberta Regional Health Authority Sub-Region Community Both Sexes Male Female All Ages 20-34 years 35-49 years 50-64 years 65-74 years 75 + years Rates/Cases from 1995-2005 DM alone or DM & Disease First Nations Status REPORTS FROM DATABASE ADSS Website- Interactive Aspect

58. DM Incidence Primary Prevention Intervention Control No Intervention ADSS: Health Research Potential

59.  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. Key Messages

60. Questions…??? jeff.johnson@ualberta.ca stephanie.vermeulen@ualberta.ca www.ACHORD.ca

61. Average Provincial Rate = 0.23 Crude Diabetes Prevalence Rates (U20) by Region, 2005

62. Crude Diabetes Prevalence Rates (U20) in First Nations, 2006