1. The National Diabetes Management Strategy: Diabetes Facts and Figures By using these slides, you agree to the terms on the next slide. The development of these slides was made possible through financial support by Merck.

2. Terms of Use By using this web site and/or these slides and/or requesting and receiving the information on this site, you are accepting these terms of use. These slides and the related information on the The National Diabetes Management Strategy website synthesize publicly available information in a convenient format. This information is intended 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 original sources. All information is attributed to the original source. All information in these slides is copyrighted by other parties. As a visitor to this site, you are granted a limited license to use the information contained within for non-commercial use only, provided the information is not modified and all copyright and other proprietary notices are retained. The National Diabetes Management Strategy and The University of Western Ontario resides in Ontario, Canada and this site and any transactions which you enter into through this site are governed 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 Western Ontario shall not be liable for any damages, claims, liabilities, costs or obligations arising from the use or misuse of the material contained on this web site, whether such obligations arise in contract, negligence, equity or statute law. The National Diabetes Management Strategy and The University 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 other Internet resources that may be of interest. The National Diabetes Management Strategy and The University of Western Ontario does not assume responsibility for the accuracy or appropriateness of the information contained on other sites, nor do we endorse the viewpoints expressed on other sites.

3. Diabetes is a Serious Disease

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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

11. Diabetes Treatments are Among the Top 10 Most Frequently Dispensed Therapeutic Classes in Canada RankTherapeutic class Prescriptions* dispensed in 2010 (in millions) 1Cardiovasculars77,130 2Psychotherapeutics64,853 3Gastrointestinal/genitourinary36,283 4Cholesterol agents34,214 5Hormones26,650 6Analgesics25,232 7Anti-infectives (systemic)24,532 8Diabetes therapies21,348 9Neurological disorders22,773 10Diuretics17,835 *Estimated prescriptions dispensed in Canadian retail pharmacies. Includes new and refills IMS Brogan; CompuScript, 2010.

12. Diabetes Treatments are Among the Top 10 Therapeutic Classes by Worldwide Sales, 2011 IMS Health, MIDAS, December 2011 RankTherapeutic class Sales (US$ billions) % Sales growth 1Oncologics62.25.5 2Respiratory agents39.47.3 3Anti-diabetics39.211.4 4Lipid regulators38.73.7 5Anti-psychotics28.49.4 6Angiotensin-II antagonists27.4-0.7 7Anti-ulcerants26.9-6.4 8Autoimmune agents24.414.1 9Anti-depressants20.4-1.5 10HIV antivirals17.49.5 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.

13. 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.