1. Systems Dynamic Modeling Diabetes Prevalence Kenn B. Daratha, PhD Diabetes Network Leadership Team Past-Chair Representing Washington State University

2. Healthy People 2010 Goal: Through prevention programs, reduce the disease and economic burden of diabetes, and improve the quality of life for all persons who have or are at risk for diabetes Source: http://www.healthypeople.gov/Document/HTML/Volume1/05Diabetes.htm#_Toc494509746

3. Healthy People 2010 Objectives  Education  Incidence  Prevalence  Complications  Control Source: http://www.healthypeople.gov/Document/HTML/Volume1/05Diabetes.htm#_Toc494509746

4. Healthy People 2010 Objectives 5-3  Reduce the overall rate of clinically diagnosed diabetes  Baseline 40 cases/1,000 population  Target 25 cases/1,000 population Source: http://www.healthypeople.gov/Document/HTML/Volume1/05Diabetes.htm#_Toc494509746

5. Systems Dynamic Modeling Computer model simulations of diabetes population dynamics  Track rates of onset, diagnosis and death  Assess effects of interventions Source: Milstein, 2007; Charting Plausible Future for Diabetes Prevalence in the U.S.

6. Systems Dynamic Modeling POPULATION STOCK Flow from one population stock to another

7. Systems Dynamic Modeling Please think about the manner in which you might be able to control these flows POPULATION STOCK Flow from one population stock to another

8. Diabetes Prevalence 16.3% Obese = 95 th Percentile (age/gender) 15.0% Overweight = 85 th Percentile (age/gender) Obesity in last 30 years  Doubled (2-5 years)  Tripled (6-11 years)  Doubled (12-19 years) HEALTHY YOUTH Source: CDC NHANES 2003-2006

9. Diabetes Prevalence 16.3% Obese = 95 th Percentile (age/gender) 15.0% Overweight = 85 th Percentile (age/gender) Obesity in last 30 years  Doubled (2-5 years)  Tripled (6-11 years)  Doubled (12-19 years) HEALTHY YOUTH Source: CDC NHANES 2003-2006 Rate of Unhealthy Children Entering Adulthood

10. ADULTS NORMAL GLYCEMIA HEALTHY YOUTH Diabetes Prevalence Estimated to be 67% of adult population Function of obesity  33.3% of men BMI > 30  35.3% of women BMI > 30 Source: CDC NHANES 2003-2006

11. ADULTS NORMAL GLYCEMIA HEALTHY YOUTH Diabetes Prevalence Estimated to be 67% of adult population Function of obesity  33.3% of men BMI > 30  35.3% of women BMI > 30 Source: CDC NHANES 2003-2006 Rate of Obesity

12. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES HEALTHY YOUTH Diabetes Prevalence Estimated to be 25% of adult population Only area of the model allows movement upstream

13. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES HEALTHY YOUTH Diabetes Prevalence Estimated to be 25% of adult population Only area of the model allows movement upstream Rate of Disease Onset Rate of Recovery

14. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES HEALTHY YOUTH Diabetes Prevalence Estimated to be 2-3% of adult population Focus on detection

15. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Estimated to be 8% of adult population Focus on management and control

16. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Estimated to be 8% of adult population Focus on management and control Rate of Detection

17. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Unhealthy Children Entering Adulthood

18. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Unhealthy Children Entering Adulthood Diabetes Prevalence Rate of Unhealthy Children Entering Adulthood

19. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Obesity

20. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Obesity Diabetes Prevalence

21. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Disease Onset Rate of Recovery

22. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Disease Onset Rate of Recovery Rate of Recovery vs. Disease Onset Diabetes Prevalence

23. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Detection

24. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Detection Diabetes Prevalence

25. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Death

26. ADULTS NORMAL GLYCEMIA ADULTS PRE DIABETES ADULTS UNDX DIABETES ADULTS DX DIABETES HEALTHY YOUTH Diabetes Prevalence Rate of Death Diabetes Prevalence

27. Diabetes Prevalence Scenarios Total Prevalence of Diabetes per 1,000 Adults Status quo Basic diab mgmt PLUS intensive diab mgmt PLUS basic pre-DM mgmt PLUS intensive pre- DM mgmt PLUS obesity reductions 200 150 100 50 0 19801990200020102020203020402050 Time (Year) Source: Model Runs DOH (Sitaker, 2009)

28. Closing Thought Objectives 5-3  38% Reduction in the overall rate of clinically diagnosed diabetes? Number of new cases > deaths Increased detection Decreased mortality Source:Source: Milstein, 2007; Charting Plausible Future for Diabetes Prevalence in the U.S.