Diabetes: The Experience of Spain

Isabel Fernández FernándezDirector of the Diabetes Plan of Andalusia

10th Meeting of the MGSD

Istanbul 2007

Diabetes

• it is a frequent problem of health

• it causes problems,

• the situation admits improvements

1921

17 Autonomous communities

-1 y 2 : Post 2006Due to his recent beginning we have not information

Tasas de ingresos por complicaciones agudas:cetoacidosis, descompensación hiperosmolar% desviación respecto a la media española

-100%

-50%

0%

50%

100%

Andalucía

Aragón

Asturias

Baleares

Canarias

Cantabria

Castilla y León

Castilla-La Mancha

Cataluña

C. Valenciana

Extremadura

Galicia

Madrid

Murcia

Navarra

P. Vasco

La Rioja

Ceuta y Melilla

España, 2004

Cetoacidosis

Descompensación Hiperosmolar

Admissions ratio for acute complicationsPercentage of diversion with regard to the National average

- Spain 2004 - Cetoacidois- Hyperosmolar comma

Tasas de ingresos por complicaciones crónicas:amputaciones% desviación respecto a la media española

-100%

-50%

0%

50%

100%

Andalucía

Aragón

Asturias

Baleares

Canarias

Cantabria

Castilla y León

Castilla-La Mancha

Cataluña

C. Valenciana

Extremadura

Galicia

Madrid

Murcia

Navarra

P. Vasco

La Rioja

Ceuta y Melilla

España, 2004

Amputaciones

Admissions ratio for amputations

Percentage of diversion with regard to the National average

-Spain

- Amputations

Tasas de ingresos por complicaciones crónicas:infartos de miocardio, ictus% desviación respecto a la media española

-100%

-50%

0%

50%

100%

Andalucía

Aragón

Asturias

Baleares

Canarias

Cantabria

Castilla y León

Castilla-La Mancha

Cataluña

C. Valenciana

Extremadura

Galicia

Madrid

Murcia

Navarra

P. Vasco

La Rioja

Ceuta y Melilla

España, 2004

Infarto agudo de miocardio

Ictus

Admissions ratio for vascular chronic complicationsPercentage of diversion with regard to the National average- Spain 2004 - Heard attak- Stroke-

Ingresos por complicaciones de la diabetes en España, 1999-2004

0

10

20

30

40

50

60

70Ta

sas/

100.

000

habi

tant

es

Cetoacidosis, ESPAÑA 10,96 11,00 11,69 11,57 11,94 12,68

Desc.Hiperosmolar, ESPAÑA 4,35 3,97 3,93 3,81 3,59 3,67

IAM, ESPAÑA 25,52 27,48 31,88 35,35 39,93 40,27

AVC, ESPAÑA 40,12 42,89 45,24 45,42 48,14 54,00

Amputaciones, ESPAÑA 14,13 14,05 14,74 15,32 15,90 16,38

1999 2000 2001 2002 2003 2004

* *

**

*

***

17 Autonomous communities

* Pre 2003

* Post 2006* Diabetes Progams

*

*

Comprehensive Diabetes Plan

FOR ANDALUSIA

2003-2007

Andalusian Public Health System

Andalusian Map

Strategies1. Public communication and information2. Prevention of diabetes3. Healthcare: Management of the Comprehensive

Healthcare Process: disease management4. Special actions5. Associations of diabetes patients6. Information systems7. Research line8. Training line.9. Promotion of the Andalusian healthcare network10. Regulations: Diabetes Advisory Committee

Integral Plan

Disease Management

Diabetes Education

Implantation of Disease Management Phase II. October 2006

Dirección General de Asistencia Sanitaria Subdirección de Coordinación Sanitaria

Fuente: Unidad de Coordinación de Procesos Asistenciales Integrados

IMPLANTADO

NO IMPLANTADO

YesNo

Diabetes Mortality Andalucía, 1996-2004

15

16

17

18

19

20

21

22

Tas

as d

e m

ort

alid

ad e

stan

dar

izad

as p

or

edad

/10

0.00

0 h

abit

ante

s

Mortality ratio Men HombresMortality ratio womenTrend mortality ratio (men)Trend mortality ratio (women

Mortality Ratio men 18,51 17,76 19,36 18,10 18,21 18,99 19,02 18,65 17,96

Mortality Ratio women 20,36 19,44 20,85 19,63 18,98 18,30 18,44 18,10 15,70

1996 1997 1998 1999 2000 2001 2002 2003 2004

Years potential life Lost (YPLL) for Diabetes in Andalucía (1996-2004)Standardized ratio for 100.000 inhabitants

20

25

30

35

40

45

50

55

60

65

Ta

sas

est

an

da

riza

da

s p

or

10

0.0

00

ha

bita

nte

s

YPLL (ratio) Men

YPLL (ratio) Women

Trend YPLL (men)

Trend YPLL (women)

YPLL (ratio)Men 55,09 59,01 57,93 48,92 47,61 51,51 52,37 49,00 49,47

YPLL (Ratio) Women 25,52 31,22 32,23 28,89 30,97 28,68 27,65 30,53 21,91

1996 1997 1998 1999 2000 2001 2002 2003 2004

Patients Admited in Hospital with chronic complications of diabetes in Andalucía, 1999-2004

0

10

20

30

40

50

60

70Ta

sas/

100.

000

habi

tant

es

Cetoacidosis, Andalucía 9,90 9,75 10,52 9,98 10,49 11,60

Desc.Hiperosmolar, Andalucía 3,37 3,46 3,47 3,28 2,97 2,80

IAM, Andalucía 32,03 34,10 36,56 39,69 43,29 42,00

AVC, Andalucía 43,02 45,69 48,34 49,77 49,01 56,38

Amputaciones, Andalucía 16,58 16,35 16,87 17,26 18,58 18,65

1999 2000 2001 2002 2003 2004

Admission ratio for acute complications, Cetoacidosis, Hyperosmolar comma

Percentage of diversion with regard to the Andalusian average

-100%

-50%

0%

50%

100%

ALMERIA

CADIZ

CORDOBA

GRANADA

HUELVA

JAEN

MALAGA

SEVILLA

ANDALUCÍA, 2005

Cetoacidosis, 2005

Hyperosmolar, 2005

Adnmision ratio for chronic complications: Heart attack, Stroke

Percentage of diversion with regard to the Andalusian average

-100%

-50%

0%

50%

100%

ALMERIA

CADIZ

CORDOBA

GRANADA

HUELVA

JAEN

MALAGA

SEVILLA

ANDALUCÍA, 2005

HA, 2005

Stroke, 2005

Admissions ratio for amputations% desviación respecto a la media andaluza

-100%

-50%

0%

50%

100%

ALMERIA

CADIZ

CORDOBA

GRANADA

HUELVA

JAEN

MALAGA

SEVILLA

ANDALUCÍA, 2005

Amputations, 2005

Coverage on total population

0,0%

0,5%

1,0%

1,5%

2,0%

2,5%

3,0%

3,5%

4,0%

4,5%

5,0%

jun-03 1,05% 0,44% 0,21% 0,42%

jun-04 2,57% 1,13% 0,51% 0,97%

dec-04 3,13% 1,30% 0,63% 1,09%

dec-05 3,83% 0,74% 0,31% 0,62%

jun-06 4,53% 0,69% 0,29% 0,49%

Cov. total Cov. HbA1c Cov. FO Cov. foot ex

Coverage on patients with diabetes

0%

20%

40%

60%

jun-03 42,02% 20,39% 40,38%

jun-04 43,84% 19,91% 37,92%

dec-04 41,41% 20,09% 35,00%

dec-05 19,30% 8,14% 16,09%

jun-06 15,19% 6,43% 10,80%

% HbA1c % OF ex % Foot ex

Technological equipment

Retinographs Primary Care: 92

Angiographs: 9 / Lasertherapy: 9

Retinographs Day Hospital / MI: 6

Other strategies

Special actions: children, pregnants, institutionalized disabled Associations of diabetes patients

Information systemsResearch lineTraining line.

Regulations: Diabetes Advisory Committee

Integral Plan of Diabetes

EBM

Disease Management

Diabetes Education

Training

Tecnology

Expectations

Material of treatment and recipes

Foot Care

Information

Summer Camps

Innovation

Research

Comprehensive Diabetes Plan

FOR ANDALUSIA

2003-2007

Andalusian Public Health System

Thank you