1. Jeffrey A. Johnson, PhD Stephanie U. Vermeulen, MSc. University of Alberta & Institute of Health Economics April 25, 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 Organization Structure ADSS Steering Committee ACHORD/IHE Jeff Johnson Stephanie Vermeulen Greg Hugel Sheri Pohar Sherry Lydynuik ADSS Staff ACHORD/IHE Epi WG HC Utilization WG First Nations WG Eye Disease Kidney Disease WG Mental Health WG CVD WG AHW

11. 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

12. National Diabetes Surveillance System

13. 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

14. 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

16. Alberta Diabetes Prevalence (Age-Adjusted Rates)

17. Alberta Diabetes Prevalence (Case Counts)

18. Alberta Diabetes Incidence (Case Counts)

19. Alberta Diabetes Prevalence Age-Specific Rates, 2006

20. Alberta Diabetes Prevalence Age-Adjusted Rates, 2006

21. Diabetes Prevalence in Palliser (Case Counts)

22. Prevalence Rates by Community (Age-Adjusted) 2006

23. Diabetes Prevalence Rates for Oyen, (Age-Adjusted) 1995-2006

24. Diabetes Prevalence (Case Counts) 2006

25. Palliser Diabetes Incidence (Case Counts) 2006

26. Incidence Rates by Community (Age-Adjusted) 2006

27. Diabetes & Mortality (Age-Adjusted) 1995-2005

29. Physician Visits (1995-2005) General Practitioners Specialists*

30. Physician Visits by Region (2005) Specialists* General Practitioners Palliser Average =10.7 Palliser Average = 3.6

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) Palliser Diabetes = 1.4

34. Hospital Days (Age/Sex Adjusted, 1995-2005)

35. Hospitalization Days by Region (Age/Sex Adjusted, 2005) Palliser Diabetes = 2.2

37. Diabetes & CVD Acute Coronary Syndrome, 1995-2005

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

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

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

43. Diabetes & Eye Disease Laser Photocoagulation, 2006

44. Crude Rates of Retinal Laser Treatment (Photocoagulation), 1995-2006 Chinook average in 2006: 99/10,000 Palliser average in 2006: 558/10,000

45. Diabetes and the Under 20 Population

46. Under 20: Crude Diabetes Prevalence Rates by Region, 2005 Average Provincial Rate = 0.23

47. 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

48. Alberta Diabetes Atlas 2007 Key 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.

49. Alberta Diabetes Fact Sheet 2008

50. ADSS - what is missing…? - what is next…? Conditions:  DM & pregnancy  DM & foot disease  DM & cancer New data:  Laboratory surveillance  Drug Utilization  Risk factor surveillance

51. How YOU can use the ADSS… 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.

52. 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, D. Friesen, R. Lewanczuk

53. 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

54. 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

55. DM Incidence Primary Prevention Intervention Control No Intervention ADSS – Health Research Potential …

56.  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…

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