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Diabetes is aWorldwide Problem

Diabetes is a Worldwide Epidemic

2011 2030

Total world population (billions) 7.0 8.3

Adult population (20–79 years, billions) 4.4 5.6

Diabetes

Global prevalence (%) 8.3 9.9

Number of people with diabetes (millions) 366 552

In 2012, there were an estimated 371 million people with diabetes.In 2011, there were an estimated 366 million people with diabetes

(8.3% of the world’s population)By 2030, the prevalence is projected to rise to 522 million (9.9%)

International Diabetes Federation. IDF Diabetes Atlas. Update 2012.International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5 th edition 2011.

Global Diabetes Statistics

• Since 1980, the number of adults with diabetes worldwide has doubled. (1)

• There will be an estimated 70% increase in the number of adults with diabetes in the developing world, and a 20% increase in the developed world between 2010 and 2030. (2)

• Each year, approximately 78,000 children worldwide develop type 1 diabetes. (3)

1. Danaei G, et al. Lancet. 2011;378(9785):31-40.2. Shaw JE, et al. Diabetes Res Clin Pract. 2010;87:8-14.3. IDF Diabetes Atlas. 5th Edition. 2011

Number of People with Diabetes:Top 10 Countries

2011 2030

Country/territory Number of people with diabetes

(millions)

Country/territory Number of people with diabetes

(millions)China 90.0 China 129.7

India 61.3 India 101.2

USA 23.7 USA 29.6

Russian Federation 12.6 Brazil 19.6

Brazil 12.4 Bangladesh 16.8

Japan 10.7 Mexico 16.4

Mexico 10.3 Russian Federation 14.1

Bangladesh 8.4 Egypt 12.4

Egypt 7.3 Indonesia 11.8

Indonesia 7.3 Pakistan 11.4

International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5 th edition 2011.

Prevalence of Diabetes:Top 10 Countries

2011 2030

Country/territory Prevalence of diabetes (%)

Country/territory Prevalence of diabetes (%)

Kiribati 25.7 Kiribati 26.3

Marshall Islands 22.2 Marshall Islands 23.0

Kuwait 21.1 Kuwait 21.2

Nauru 20.7 Tuvalu 20.8

Lebanon 20.2 Nauru 20.7

Qatar 20.2 Saudi Arabia 20.6

Saudi Arabia 20.0 Lebanon 20.4

Bahrain 19.9 Qatar 20.4

Tuvalu 19.5 Bahrain 20.2

United Arab Emirates

19.2 United Arab Emirates

19.8

International Diabetes Federation. Global burden. IDF Diabetes Atlas. 5 th edition 2011.

Leading Causes of Global Death:2004 and 2030

2004 2030

Disease Deaths Rank Rank Deaths

Heart disease 12.2 1 1 14.2

CVD 9.7 2 2 12.1

Pneumonia 7.0 3 4 3.8

HIV/AIDS 3.5 6 10 1.8

Lung cancer 2.3 8 6 3.4

Diabetes 1.9 12 7 3.3

Malaria 1.7 13 41 0.4

Breast cancer 0.9 23 19 1.1

Chronic conditions have overtaken infectious diseasesas the leading causes of global death.

World Health Statistics. World Health Organization; 2008.

US Diabetes Statistics

• 25.8 million Americans (8.3% of the US population) have diabetes:– Diagnosed: 18.8 million people– Undiagnosed: 7.0 million people– Prediabetes: 79 million people

• One in every 400 American children is currently diagnosed with diabetes.

National Diabetes Fact Sheet 2011. Centers for Disease Control and Prevention.

Diabetes is aCanadian Problem

Diabetes is the Sixth LeadingCause of Death in Canada

Cause of death Rank Number

All causes of death − 226,584

Cancer 1 66,947

Heart diseases 2 52,000

Stroke 3 14,626 Chronic lower respiratory diseases 4 10,041

Accidents (unintentional injuries) 5 8,986

Diabetes 6 7,823

Influenza and pneumonia 7 5,729

Alzheimer’s disease 8 5,536

Suicide 9 3,613

Kidney diseases 10 3,541

All other causes − 47,742

Statistics Canada. Leading causes of death in Canada, 2000 to 2004.

Canada has one of the highest prevalence of diabetes amongst OECD member countries

* Although there are 30 OECD member countries, some countries had equal age-adjusted prevalence, so in this table of selected countries, the ranking ranges from only 1 to 20. ** Age-standardized prevalence adjusts the national prevalence to the age profile of the world and is useful for comparing prevalence between nations. Source: Prevalence of diabetes in OECD countries, 2010. Available at http://www.ecosante.fr/OCDEENG/68.html Accessed June 21, 2011

http://www.ecosante.fr/OCDEENG/68.html

Canada Has a Chronic Disease Surveillance System

• The Canadian Chronic Disease Surveillance System (CCDSS) uses population-based administrative data from every province and territory. In each province and territory, the health insurance registry database is linked to physician billing and hospitalization databases

• An individual is identified as having diagnosed diabetes, if: – At least one hospitalization with diagnosis of diabetes; or – At least two physician visits with a diagnosis of diabetes within a 2-year period – Gestational diabetes mellitus excluded

• Current national database includes summary data on individuals 1 year or older at time of diabetes diagnosis from all provinces and territories from 1995/96 to 2008/09

• Age-standardized data are adjusted to 1991 Census data

• Can’t distinguish between type 1 and type 2

• Validated methodology

Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.

Prevalence of Diagnosed Diabetes

• Overall prevalence: 6.8% (N=2,359,252)– Males: 7.2% (n=1,238,826) – Females: 6.4% (n=1,120,426)

• Age standardized prevalence: 5.6%

The prevalence of diagnosed diabetes in Canada in 2008–2009 was 6.8% (approximately 2.4 million people aged 1 year or older).


Diabetes Prevalence Increases With Age

• Prevalence increase with age and sharply increases in middle age:– 35-39 years: 2.6% – 50-54 years: 8.4%– 75-79 years: 25.5%


Increase in Prevalence of Diagnosed Diabetes

• After adjusting for differences in age distributions among the provinces between 1998/99 and 2008/09, the prevalence of diabetes:• increased by 70%• was higher in men than women• Increased in every age category

• The prevalence of diabetes in Canada is expected to increase 3.7 million by 2018/19


Prevalence of Diagnosed Diabetes Varies by Province

Province/territory PrevalenceNewfoundland and Labrador 6.5

Nova Scotia 6.1Ontario 6.0

New Brunswick 5.9Manitoba 5.9

Prince Edward Island 5.6Northwest Territories 5.5

Saskatchewan 5.4British Columbia 5.4

Yukon 5.4Quebec 5.1Alberta 4.9

Nunavut 4.4


Implications of Variable Provincial Diabetes Prevalence Rates

• Implications for provincially specific:– human and financial resource planning– population-based prevention strategies– individual risk factor reduction– screening for diabetes and pre-diabetes, and– management

The Incidence of Diabetes in Canada is Increasing

• The overall incidence of diabetes in 2008/09 was 6.3 per 1000 people (or 203,018 Canadians).

• Among people aged 1 year or older, 203,018 individuals were given a new diagnosis of diabetes: – 6.3 per 1000 individuals – 5.7 per 1000 girls/women – 6.8 per 1000 boys/men

• Rates of new diagnosis of diabetes show a similar trend as prevalence with rates that rise steeply after age 45 and peak among those aged 70–74 for both men and women.


Diabetes in Canada: 2007 to 2017

• Between 2007 and 2017, an estimated 1.9 million Canadians (aged 20 years and older) will be newly diagnosed with diabetes.

• This means that about nine out of every 100 Canadians are predicted to be newly diagnosed with diabetes during the 10-year period.

Manuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.

Diabetes in Ontario

• In Ontario from 1995 to 2005, the number of adults with diabetes increased by 113%, while the population grew by only 17%.1

• The prevalence of diabetes is increasing in Ontario at a rate of approximately 6% per year.1

• There are currently an estimated 1.2 million people (8.2% of the population) diagnosed with diabetes in Ontario.2

• This is projected to increase to more than 1.9 million people (11.9% of the population) by 2020.2

Lipscombe LL, Hux JE. Lancet. 2007;369:750-756.

Canadian Diabetes Association. The Burden of Diabetes in Ontario. http://www.diabetes.ca/get-involved/news/diabetes-cost-model-released-in-ontario/

http://www.diabetes.ca/get-involved/news/diabetes-cost-model-released-in-ontario/

Incidence of Diabetes in Ontario

• Factors that may have affected prevalence in Ontario from 1995–2005:– Longevity: People with and without

diabetes are living longer: 25%reduction in standardized mortalityfrom 1995 to 2005.

– Obesity: In Canada alone, rates have increased by 20 to 30% in the last decade. WHO diabetes prevalence estimates were based on the unwarranted assumption that obesity rates would remain constant.

Lipscombe LL, Hux JE. Lancet. 2007;369:750-756.

Incidence of Diabetes in Ontario (cont’d)

• Other factors that may have affected prevalence in Ontario from 1995–2005:– Immigration: Ontario had a 51% increase

in immigrants from South Asia from 1995to 2001.

– Incidence: Record rise of 31% from 1997to 2003.

– Guidelines: Publication of diabetesguidelines may have enhancedscreening and detection rates.

• The implications ... The size of the diabetes epidemic is far greater than was anticipated.

Lipscombe LL, Hux JE. Lancet. 2007;369:750–756.

Factors Affecting the Prevalence and Incidence of

Diabetes in Canada

An Aging Population

• The prevalence of diabetes begins to increase steadily after age 40.

• The proportion of senior citizens in Canada’s overall population is increasing.1 – In 2006, seniors accounted for 13.7% of the total

population.2 – By 2031, seniors will account for approximately 24%

(almost double 2006 levels).2

1. Canadian Diabetes Association Clinical Practices Guidelines Expert Committee.Can J Diabetes. 2008;32(suppl 1) :S1–S201.

2. Statistics Canada. Population projections 2005–2031. 3. Statistics Canada. 2006 Census: Age and Sex.

An Aging Population (cont’d)• By the year 2056, the median age of Canadians

will be 45–50 years.1

• Guidelines recommend screening starting at age 40. Therefore… over half the population will have at least one risk factor (age >40) and should be regularly screened for diabetes.2

1. Statistics Canada. 2006 Census: Age and Sex. 2. Canadian Diabetes Association Clinical Practices Guidelines Expert Committee. Can J

Diabetes. 2008;32(suppl 1) :S1–S201.

An Aging Population (cont’d)• Aging trends vary by province, with important

implications for regional healthcare planning and policy.

• Proportion of seniors according to the 2006 Census:– National average: 13.5% – Saskatchewan: 15.4% (highest) – Alberta: 10.7% (lowest)

Statistics Canada. 2006 Census: Age and Sex.

Increasing Immigration FromHigh-risk Populations

• Most recent immigrants come from populations at high risk for developing diabetes

• Of immigrants who came to Canada from 2001–2006, approximately 80% were from populations at increased risk of developing diabetes: – 58.3% came from Asia – 10.6% came from Africa – 10.8% came from Central/South America and

the Caribbean

Statistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration.

Implications of Immigration Patterns for Diabetes Prevalence and Incidence

• Healthcare system will need to respond to the specific healthcare needs of these populations with culturally and linguistically relevant prevention, screening and management practices.

• Major cities (Toronto, Vancouver, Montreal) are home to the majority of recent immigrants (69%), with implications for local healthcare planning.

Statistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration.

Percentage of Foreign-born Canadians is Increasing

• By 2031, between 25% and 28% of the population could be foreign-born.

• Between 29% and 32% of the population could belong to a visible minority group, as defined in the Employment Equity Act.

• This would be nearly double the proportion reported by the 2006 Census.

Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.

The Percentage of Foreign-born Canadians Is Increasing (cont’d)

• About 55% of this population would be born in Asian countries, which have a very high incidence and prevalence of type 2 diabetes.

• In addition, Canada’s Black and Filipino populations could double,and Arab and West Asian groups could more than triple.

Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.

Increasing Prevalence of Adultand Childhood Obesity

• In 2008, of adult Canadians:– 51% being overweight– 17% reported being obese.1

• From 2003 to 2008, obesity rates rose:– from 16% to 18% in men– from 15% to 16% in women

• The highest rate of obesity (22%) was among55 to 64 year olds– 24% of men– 21% of women1

• In boys and girls aged 2–17 years, prevalence of obesity from 1978/1979 to 2004 increased from 3% to 8%.2

1. Statistics Canada. Canadian Community Health Survey, 2008.2. Lau DCW, et al. CMAJ. 2007;176(8 Suppl):S1–13.

Overweight, Obesity and Diabetes

• Between 2007 and 2017, it is estimated that people who are overweight (BMI 25–30 kg/m2) will comprise the greatest number of new cases of diabetes (712,000)

• While those who are overweight have lower baseline risk than those who are obese (BMI 30–35 kg/m2) or morbidly obese (BMI >35 kg/m2), there are more more Canadians who are overweight than obese

Manuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.

Low Levels of Physical Activity

• In 2008, only 51% of Canadians reported being at least moderately active during their leisure time.

• “Moderately active” is equivalent to walking at least 30 minutes a day or taking an hour-long exercise class at least 3 times a week.

Statistics Canada. Canadian Community Health Survey, 2008.

Socioeconomic & Environmental Impact on Health:Canadians Living in Poverty

• Health follows a social gradient: populations in a lower position in the social hierarchy experience the worst health

• More than 12% of the working-age population lives in poverty.1

• People who live in poverty are:– often unable to meet basic housing, food and security needs

– have a greater risk of health problems than people who do not live in poverty

• Compared to those in the highest-income neighbourhoods, life expectancy in the lowest-income quintile neighbourhoods in Canada is:– 5 years shorter for men– 1.6 years shorter for women2

1. Canada’s Record on Poverty Among The Worst of Developed Countries−And Slipping. Available at: http://www.conferenceboard.ca.

2. Ontario Medical Review. 2008;May:32-37.

Socioeconomic & Environmental FactorsDiabetes Disproportionately Affects the Poor

• Diabetes is disproportionately clustered:1

– in the lower socioeconomic status quintiles

– in neighbourhoods with:• lower average household incomes

• high proportions of visible minorities and/or recent immigrants

• In 2007, the self-reported age-standardized diabetes prevalence rate was highest among adults with a household income of <$20,000 (8%)

• This rate was double that of the group with an income of $60,000 (4%).2

1. Hux JE, et al. In: Diabetes in Ontario: An ICES Practice Atlas: Institute for Clinical and Evaluative Sciences. 2. Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada December 2009.


• People in lower income brackets and with fewer years of education also report the following (all of which are risk factors for diabetes): – Higher rates of smoking – Less physical activity; and – Higher rates of overweight

Statistics Canada. National Population Health Survey – Household Component Longitudinal, 1998–1999.


• The poor are disproportionately affected by some diabetes risk factors.

• Some risk factors for type 2 diabetes are more common among Canadians in the lowest income quintiles compared with those in the highest income quintiles. These include:– physical inactivity– inadequate fruit and vegetable consumption– daily smoking


Socioeconomic Status Also Affects Diabetes Care

• In 2007, people with higher household incomes were more likely to receive:– an A1C test– a urine test for protein– a dilated eye exam – a foot exam– all 4 recommended tests

• The age-standardized percentage of adults with diabetes receiving all 4 recommended tests was:– highest in the highest household income group (42%)– lowest in the lowest household income group (21%)

Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada; December 2009.

Diabetes is an Aboriginal Problem

Diabetes is an Epidemic in Aboriginal Populations

• The national age-adjusted prevalence is 2.5 to 5 times higher than that of the general population.

• Age-adjusted prevalence rates as high as 26% have been found in individual communities.

• Aboriginal peoples are diagnosed with type 2 diabetes at a much younger age, with high rates of diabetes in children and adolescents.

Dyck R, et al. CMAJ. 2010; 182(3):249-256.Green C, et al. Diabetes Care. 2003;26:1993–1998.Harris SB, et al. Diabetes Care. 1997;20:185–187.Fagot-Campagna A, et al.. J Pediatr. 2000;136:664–672.

Aboriginals are Disproportionately Affected by Diabetes

Population Data source Age of surveyed

population

Prevalence (%)(95% confidence interval)

Crude Age-standardized

Non-Aboriginal

2009-10 CCHS

12+6.0

(5.8-6.3)5.0

(4.3-5.7)First Nations(on-reserve)

2008-2010 RHS

18+15.3

(14.2-61.4)17.2

(16.5-19.0)First Nations(off-reserve)

2009-10 CCHS

12+8.7

(7.0-10.4)10.3

(3.4-17.2)

Inuit2006 APS

15+4

(3.3-5.6)NA

Métis2009-10 CCHS

12+5.8

(4.4-7.3)7.3

(2.2-12.5)

Self-reported diabetes among Aboriginal and First Nations populations is higher than in the non-Aboriginal populations.

APS = Aboriginal Peoples Survey; CCHS = Canadian Community Health Survey; RHS = First Nations Regional Longitudinal Health Survey

Younger Age of Diagnosis Among First Nations Peoples

General population with type 2 diabetes

in family practice setting

(2003-2003) (1)

General population with type 2 diabetes

in family practice setting

(2005-2006) (2)

First Nations population with type

2 diabetes in 19 communities

(2007)(3)

54.9 years 55 years 43.7 years

Compared with the general population of people with type 2 diabetes, First Nations peoples were

diagnosed with diabetes on average a decade earlier.

1. Harris S, et al. Diabetes Res Clin Pract. 2005;70(1):90-97. 2. Braga M, et al. Can J Cardiol. 2010;26(6):297-302. 3 Harris SB, et al. Diabetes Res Clin Pract. 2011;92(2):272-279.

Higher Rates of Complications in First Nations Peoples With Diabetes

Complication First Nations population with type 2

diabetes in 19 communities (2007) 1)

General population with type 2 diabetes in family practice setting (2002-

2003) (2)

Age at audit 54.9 62.7

Chronic kidney disease 55.1 6.0

Depression 21.1 14

Neuropathy 10.8 8.0

Retinopathy 10.7 7.0

Diabetic foot disease 5.5 2.0

Number of diabetes-related health visits 8.7 4.3

Compared with the general population with type 2 diabetes, First Nations peoples with diabetes are younger, yet have higher rates of many of the serious complications of diabetes. This higher morbidity is reflected in double the number of diabetes-related health visits in First

Nations than in the general population with type 2 diabetes.

1. Harris SB, et al. Diabetes Res Clin Pract. 2011;92(2):272-279.2. Harris S, et al. Diabetes Res Clin Pract. 2005;70(1):90-97.

http://www.ncbi.nlm.nih.gov/pubmed/15890428

High Rates of GDM in Aboriginal Women

Population Prevalence (%)Non-Aboriginal 0.5First Nations 4.8

Inuit 4.0Métis 2.2

Gestational diabetes mellitus (GDM) is defined as diabetes with onset or first recognition during pregnancy.It is a risk factor for later development of type 2 diabetes

in the mother, as well as in the offspring.

Garnier R, et al. Statistics Canada Health Analysis Division; Ottawa, ON: 2010.PHAC. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011

Increased Prevalence of Diabetes in Pregnancy and Adverse Outcomes

Liu S, et al. Diabetic Med. 2012: [Epub ahead of print]

• Compared to non-FN women, FN women on-reserve in Ontario had:– Higher prevalence of diabetes in pregnancy– Less preconception/antenatal care– Less postpartum care– Higher mean birth weight and rate of macrosomia

– Higher rates of pre-term delivery, jaundice, neonatal hypoglycemia, shoulder dystocia

– Less primary care after birth

Aboriginal Population Growth• Type 2 diabetes has reached epidemic proportions among

Canadian Aboriginal peoples.• The national age-adjusted prevalence is 2.5 to 5 times higher

than that of the general population, and age-adjusted prevalence rates as high as 26% have been found in individual communities.1-3

• Aboriginal peoples are diagnosed with type 2 diabetes at a much younger age, with high rates of diabetes in children and adolescents.4

• Due primarily to a high birth rate, from 1996 to 2003, the Aboriginal population grew by 45%, nearly 6 times the growth rate of non-Aboriginals.5

1. Dyck R, et al. CMAJ. 2010; 182(3):249-256. 2. Green C, et al. Diabetes Care. 2003;26:1993–1998. 3. Harris SB, et al. Diabetes Care. 1997;20:185–187.

4. Fagot-Campagna A, et al. J Pediatr. 2000;136:664–672. 5. Statistics Canada. Aboriginal population in 2017.

Diabetes Surveillance System forFirst Nations Communities

• The First Nations Diabetes Surveillance System is a web-based surveillance application that will track type2 diabetes and complication rates over time in First Nations communities.

• This information will allow the monitoring of the diabetes burden in each partnering community and can be used to inform and evaluate new quality improvement initiatives in communities.

• The goal of the Surveillance System is to monitor and track diabetes rates so that informed decisions can be made to improve community care.

First Nations Surveillance System Newsletter. November 2010.

Diabetes Surveillance System forFirst Nations Communities

• Similar programs in Aboriginal settings in the United States and Australia have been associated with sustained improvements in quality of care for people diagnosed with diabetes.

• Although this program is currently a 2-year pilot program, it is hoped that in the future the system will be expanded to include other communities, and that ongoing financial support will help sustain the program.

• The Surveillance System has been generously funded by the Aboriginal Diabetes Initiative, First Nations and Inuit Health Branch at Health Canada.

First Nations Surveillance System Newsletter. November 2010.

Diabetes is a Serious Disease

Diabetes is Associated withSerious 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.

Diabetes is the Leading Causeof 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.

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.

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.

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; 364:829-841Public Health Agency of Canada. Report from the National Diabetes Surveillance: Diabetes in Canada 2009.

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.

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

Diabetes Treatments are Among the Top 10 Most Frequently Dispensed Therapeutic

Classes in Canada

Rank Therapeutic class Prescriptions* dispensed

in 2010 (in millions)

1 Cardiovasculars 77,130

2 Psychotherapeutics 64,853

3 Gastrointestinal/genitourinary 36,283

4 Cholesterol agents 34,214

5 Hormones 26,650

6 Analgesics 25,232

7 Anti-infectives (systemic) 24,532

8 Diabetes therapies 21,348

9 Neurological disorders 22,773

10 Diuretics 17,835

*Estimated prescriptions dispensed in Canadian retail pharmacies. Includes new and refillsIMS Brogan; CompuScript, 2010.

Diabetes Treatments are Among the Top 10 Therapeutic Classes by Worldwide Sales, 2011

IMS Health, MIDAS, December 2011

Rank Therapeutic class Sales

(US$ billions)% Sales growth

1 Oncologics 62.2 5.5

2 Respiratory agents 39.4 7.3

3 Anti-diabetics 39.2 11.4

4 Lipid regulators 38.7 3.7

5 Anti-psychotics 28.4 9.4

6 Angiotensin-II antagonists 27.4 -0.7

7 Anti-ulcerants 26.9 -6.4

8 Autoimmune agents 24.4 14.1

9 Anti-depressants 20.4 -1.5

10 HIV antivirals 17.4 9.5

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.

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.

Diabetes is anExpensive Disease

Diabetes is Straining Worldwide Healthcare Budgets

• In 2012, the estimated global healthcare cost to diagnose and treat diabetes is at least $471 billion USD.

International Diabetes Federation. Diabetes Atlas Update 2012.

Diabetes is Straining Canadian Healthcare Budgets

• The economic burden of diabetes in Canada is:– currently estimated to be $12.2. billion– expected to increase to $16.9 billion by 2020.

• The direct costs of diabetes currently accountfor approximately 3.5% of public healthcare spending.

Canadian Diabetes Association. An Economic Tsunami, The Cost Of Diabetes. 2009

Healthcare Costs for Diabetes Will Increase

• As the general population ages, the prevalence of diabetes and the associated costs are expected to increase.

• As the population with diabetes ages, there will be an increase in long-term complications (e.g. cardiovascular disease, kidney disease) and associated costs to treat these complications (e.g. hospitalizations, dialysis).


Diabetes is Straining American Healthcare Budgets

• In 2012, the total estimated cost of diagnosed diabetes was $245 billion – $176 billion in direct medical costs and $69 billion in reduced productivity.

• People with diagnosed diabetes have medical expenditures that are about 2.3 times higher than they would be in the absence of diabetes.

• More than 1 in 5 healthcare dollars in the US is spent on people with diabetes.

American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. Ahead of print, March 6, 2013.

Diabetes Management in Canada

CDA Publishes Clinical Practice Guidelines

• The Canadian Diabetes Association Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada are published once every 5 years (most recently in 2008)

• Represent the best and most current evidence-based clinical practice data for healthcare professionals

Many Patients Not Meeting Therapeutic Targets

• The goal of treatment is to minimize the risk of complications by aiming for guideline-recommended targets.

• Studies of Canadian patients with type 2 diabetes in the primary care setting demonstrated:– 47% to 49% were above the A1C target <7.0%1,2

– 46% were above the BP target of 130/80 mm Hg2

– 36% were above the LDL-C target of 2.5 mmol/L (2003 CDA guideline-recommended target). In the 2008 CDA guidelines, this target was lowered to 2.0 mmol/L. Had this target been applied, 63% would have been above target2

– Only 21% achieved all three key targets1

1. Braga MFB, et al. Can J Cardiol. 2010;26(6):297-302.2. Harris SB, et al. Diabetes Res Clin Prac. 2005;70(1):90-07.

Public Awareness About Diabetes is Low

Diabetes Awareness in the US

• In the US, when asked to rank which disease (diabetes, breast cancer, AIDS) caused the most deaths each year, not even half of respondents chose diabetes (42%).

• In the US, diabetes causes more deaths per year than breast cancer and AIDS combined.

• Canadian data on diabetes awareness are not available.

As America Earns Failing Grade, American Diabetes Association Launches Movement to Stop Diabetes.Available at: http://www.diabetes.org/for-media/2009/america-earns-failing-adm-sd-2009.html.

American Diabetes Association Awareness Survey

• The American Diabetes Association conducted an online survey to determine what people fear most:

– 16% feared being in a plane crash – 13% feared snake bites – 5% feared being hit by lightning – 5% feared getting an illness/disease– 4% feared a shark attack

• When asked specifically about diseases: – 49% feared cancer– Only 3% cited a fear of diabetes

• Ironically, 10% of adults reports having been diagnosed with diabetes, while fewer (6%) have been diagnosed with cancer.

• Further, cancer and diabetes have similar rates of expected new cases each year

American Diabetes Association Survey.

Education

Diabetes facts all