Escolar Documentos
Profissional Documentos
Cultura Documentos
• The Epidemiology
• Current Healthcare Delivery & Innovative
Models
• Future Policy & Program Direction
5%
8%
3%
14%
4%
300
250 221
200 177
135
150
100
30
50
0
1985 1995 2000 2010 2025 2030
Sources: www.who.int
www.idf
Zimmet P. et al Nature: 414, 13 Dec 2001
Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
The World Wide Epidemic:
Millions with Diabetes 2000 & 2030
2000
People with Diabetes
(millions)
< 30
31 - 35
36 - 40
41 - 45
46 - 50
>50
2030
250 1995
2025
200
Millions with Diabetes
150
100
50
0
Developed Countries Developing Countries
14%
12.6%
12%
Overall self-reported 10.2% 10.2%
10%
prevalence (15+): 9.6%
Prevalence (%)
8%
3.4% (n=786,000) 8.2%
5.9%
6%
4.4%
4%
2.7%
1.9%
2%
0.6% 0.5% 0.5% 0.7% 0.7%
0%
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+
Age Group
Source: Statistics Canada, National Population Health Survey, Public Use Microdata, 1996/97
Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
The Canadian Epidemic:
Prevalence in Canada, 1994/95 to 2000/01, by Province
3.2
1.3
5.8
5.2
3.4 3.9
3.1 4.0 4.0
3.1 3.1 3.4 4.1
3.10 3.1 4.0 5.0
3.6 4.2
3.3 4.4 5.1 5.2
Source: Statistics Canada: CANSIM II Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
These numbers are an
under-representation of
the true burden of
diabetes….
REF: The Australian Diabetes, Obesity and Lifestyle Study, Diabetes Care, V25 5, May 2002
Harris MI, Eastman RC, Diabetes Metab Res Rev 2000 Jul-Aug;16(4):230-6
Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
The Canadian Epidemic:
Age Distribution of Canadians with Diabetes in 2000 & 2016
400,000
350,000
2000 (n=1.4 million)
300,000
Persons with Diabetes
200,000
150,000
100,000
50,000
0
<5 5-9 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80+
14 19 24 29 34 39 44 49 54 59 64 69 74 79
Age Group
* Source: Statistics Canada Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
The Canadian Epidemic:
Alberta Prevalence
First Nations
Social Services
Subsidy
No-Subsidy
&
Non-Modifiable Risk Factors
•Ethnicity
•Family History
Physical Activity:
Relative Risk For Developing Diabetes
2
Relative Risk
0
>7 4 to 7 2 to 4 .5 to 2 <0.5
Hours per week
Healthy Diet:
Relative Risk for Developing DM
1.5
relative risk
0.5
0
5 4 3 2 1
quintiles based on fat/fibre content
Obesity:
Relative Risk For Developing DM
40
Relative Risk
30
20
10
0
<23 23-25 25-30 30-35 <35
BMI = wt/(ht) 2
1998 1999
51 47
4
60 7 55
67
67
56 57
58 63 63 68 65
69 62 72 68
6 60 61
63 65 65
3
70 73
40 to 49
2000 50 to 59
2001
60 to 69
70 to 79
58
65 49
67
65
61
56
66 62 47
63 69 65 61 59
50 59 62
59
64 62 55
63 57
Source: www.cflri.ca
Canadian Fitness & Lifestyle Research Institute
Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
Diabetes Risk Factors: Modifiable
Obesity by Province: BMI 30
< 10%
1996 1998
< 10% - 14.9%
> 15%
No data
Ethnicity
Age
Family History / Genetics
Aboriginal
Latino
South East Asian
Asian
African Descent
30
28
25 24.2
20 19.8
16.9
Canadian
11
NPHS
10
NPHS (DM)
NPHS (DM)
7.1 Sandy Lake (DM)
Sandy Lake (IGT)
5
3.3 3.2
0
Male Female
80
77.5
70 73.1 75.1 •Both measures of obesity
60 63.9 64.6 (BMI and WHR) were
50 associated with increasing
50.9 glucose intolerance for both
40 sexes
30 35
20 27
10
0
Men Women
Canada Sandy Lake (Norm) Sandy Lake (IGT) Sandy Lake (DM)
REF: Hanley AJG, Harris SB et al Diabetes Care 1997;20:185-187.
Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
Prevalence of Abdominal Obesity (WHR) by Glucose Tolerance
Status: Canada and Sandy Lake (Age-Standardized)
100
99.1
93.4 98.7
80 93.6
91.9
81.8
60
50
40
34 •WHR was shown
20 to be a significant
predictor for
0 diabetes
Men Women
Macrovascular
Heart Disease and Stroke
Microvascular
Kidneys
Eyes
Feet
1.5
1
4 5 6 7 8 9
Fasting glucose (mmol/L)
REF: Coutinho et al. Diabetes Care 1999;22:233-40.
Men with DM
Male No DM
Women with DM
Women No DM
120
100
IHD 80
admissions 60
per 10,000
persons 40
20
0
1983-1987 1988-1992 1993-1997
60
Acute MIs per 10,000 population
50
40
30
20
10
0
1980 1982 1984 1986 1988 1990 1992 1994 1996
Native Communities Northern Ontario All Ontario
250,000 228,214
200,000
158,056
CVD Hospitalizations
150,000
98,925
100,000
50,000
0
1996 2006 2016
First Nations
General Population
14,000
12,000 10,573
Amputations
10,000
8,000 6,602
6,000
4,000
2,000
0
1996 2006 2016
REF: Blanchard J, Unpublished Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
Diabetes Complications:
Microvascular – Retinopathy
Diabetes
• Is a leading cause of adult-onset
blindness
• Prevalence of diabetic retinopathy is ~ 70% in persons
with type 1 and 40% with person with type 2 diabetes.
Subsidy
No-Subsidy
4000
Projected Number of New Persons with 3,533
3500 Diabetes on Dialysis, Canada
3000
2,494
2500
2000 1,574
1500
1000
500
0
1996 2006 2016
Total Cost
$23.2* billion
$132 billion Diabetes Care
$40.1 billion
Indirect
• Primary Prevention
– Prevent diabetes through reduction of
modifiable risk factors in general population
• Secondary Prevention
– Screening those at high-risk for diabetes
• Tertiary Prevention
– Upon diagnosis of diabetes, prevention of
complications morbidity, and mortality
REF: Diabetes Blueprint
Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
Primary Prevention
• Goal
– Reducing modifiable risk factors for diabetes
• Target
– General population & high-risk groups
• Messages
– Healthy lifestyle choices
• Current Delivery Models of Primary Prevention
– Population Health
– Primary Care
CDS
Health Canada
NADA
REF: Health Canada
Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
Primary Prevention Model:
Population Health
• Despite population health initiatives
• Obesity is increasing
• Diabetes is increasing
– Are these models and strategies under-funded and
maximally coordinated?
– Are the models and strategies effective?
– Are the models and strategies evaluated?
– Are these models well suited for many high-risk
groups
• Specific innovative models are needed
• Goal
– Early identification of those with dysglycemia
• Target
– High-risk individuals and groups
• Messages
– Diabetes awareness
• Current delivery model of secondary
prevention relies on primary care
Canadian Diabetes Strategy: Time For Action, May 2003
Dr. Stewart Harris, UWO
Secondary Prevention:
Is It Effective?
• Yes….
– Patients diagnosed with IGT can be
prevented from progressing to type 2
diabetes
• 58% reduction with lifestyle changes (DPP, DPS)
• 30% reduction with medication (DPP, Stop
NIDDM)
Diabetes Management
• Goals
– Glucose, blood pressure, and lipid control to
reduce the development of complications
– Complication screening for early
identification and management