section 1: burden of diabetes the diabetes epidemic burden of diabetes complications association...
TRANSCRIPT
Section 1: Burden of diabetes
• The diabetes epidemic
• Burden of diabetes complications
• Association with major psychological distress/quality of life
• The burden of diabetes on healthcare systems
•The diabetes epidemic
Diabetes is an increasing healthcare epidemic throughout the world
Global projections for the number of people with diabetes (20–79 age group), 2007–2025 (millions)
IDF. Diabetes Atlas 3rd Edition - 2006
28.340.5
+43%
16.232.7
+102%
24.544.5+81%
10.418.7
+80%
53.264.1+21%
67.099.4
+48%
46.580.3+73%
Worldwide:246 million people in 2007
380 million projected for 202555% increase
AfricaEastern Mediterraneanand Middle EastEuropeNorth AmericaSouth and Central AmericaSouth-East AsiaWestern Pacific
World
246
380
+55%
2007:
2025:
Increase:
China2007: 4.3% – 39,8102025: 5.6% – 59,270
•The diabetes epidemic
Diabetes prevalencein Asia is high and increasing
Prevalence rates and numbers of adults with diabetes (1,000s)
IDF. Diabetes Atlas 3rd Edition - 2006
Philippines2007: 6.5% – 3,0552025: 7.9% – 5,573
Korea2007: 8.6% – 3,074
2025: 10.8% – 4,163
Thailand2007: 7.2% – 3,1622025: 8.9% – 4,660
Bangladesh2007: 4.8% – 3,8482025: 6.1% – 7,419
Indonesia2007: 2% – 2,888
2025: 2.8% – 5,129
Malaysia2007: 9.9% – 1,531
2025: 12.3% – 2,743Australia2007: 6.4% – 926
2025: 7.7% – 1,346
India2007: 6.2% – 40,8512025: 7.6% – 69,882
•The diabetes epidemic
Diabetes prevalence in theMiddle East and Africa is high and increasing
Prevalence rates and numbers of adults with diabetes (1,000s)
IDF. Diabetes Atlas 3rd Edition - 2006
Algeria2007: 7.3% – 1,4752025: 8.9% – 2,528
Egypt2007: 10.1% – 4,357 2025: 12.2% – 7,650
Pakistan2007: 8.3% – 6,929
2025: 8.5% – 11,538
Iran2007: 6% – 2,565
2025: 8.4% – 5,115
Morocco2007: 7.1% – 1,3602025: 9.1% – 2,396
Saudi Arabia2007: 13.5% – 1,8552025: 15.7% – 3,610
South Africa2007: 4.5% – 1,2132025: 4.4% – 1,279
Lebanon2007: 7.4% – 1672025: 9.1% – 267
Israël2007: 7.8% – 3372030: 8.5% – 495
Tunisia2007: 4.8% – 3172025: 6.2% – 535
•The diabetes epidemic
Diabetes prevalence inLatin America is high and increasing
Prevalence rates and numbers of adults with diabetes (1,000s)
IDF. Diabetes Atlas 3rd Edition – 2006
Mexico2007: 9.4% – 6,116
2025: 12.2% – 10,811
Argentina2007: 6% – 1,488
2025: 6.4% – 1,996
Brazil2007: 5.8% – 6,913
2025: 11.4% – 17,627Chile
2007: 5.9% – 645 2025: 6.9% – 945
Colombia2007: 4.6% – 1,278 2025: 5.9% – 2,251
Peru2007: 5.4% – 894
2025: 6.6% – 1,544
Venezuela2007: 4.9% – 795 2025: 6% – 1,388
IRAN
• 3/6 MILLION DIABETIC --- 7/7 MILLION IGT IN 1387
• BUSHER 8% DIABETIC----12% PREDIABETIC
• TEHRAN 7/2% DIABETIC----8/2% PREDIABETIC
• YAZD 14% DIABETIC-
• ZANJAN 4/3%DIABETIC----2/3% PREDIABETIC
•The diabetes epidemic
In developing countries, diabeteswill affect people aged 45−65 years
1. Wild S et al. Diabetes Care 2004;27(5):1047–1053
0
20
40
60
80
100
120
140
160
20–44 45–64 65+
2000
2030
Estim
ated
num
ber o
f peo
ple
with
dia
bete
s (m
illio
ns)
0
10
20
30
40
50
60
20–44 45–64 65+
2000
2030
Developed Countries Developing Countries
Estim
ated
num
ber o
f peo
ple
with
dia
bete
s (m
illio
ns)
• T2DM:1
– About 90% of the diabetes population
– Dual impairment: insulin deficiency & insulin resistance
– No longer a disease of adults only– Obesity– Genetic link– 15% of diabetic children aged 10-19
• T1DM:2
– 5 to 10% of diabetes cases– Huge geographical variations
of incidence rates:• A 100-fold higher rate
reported in Finland and Sardinia than China
– 50–60% of cases occur before the age of 16–18 years
– Absolute insulin requirement– Autoimmune mediated
1. Stumvoll M. Lancet 2005;365:1333–13462. Daneman D. Lancet 2006;367:847–858
•The diabetes epidemic
T2DM accounts for thevast majority of diabetes mellitus cases
DiabeticRetinopathyLeading causeof blindnessin adults1,2
DiabeticNephropathyLeading cause of end-stage renaldisease3,4
CardiovascularDisease
Stroke2- to 4-fold increase in CV mortality and stroke5
DiabeticNeuropathyLeading cause ofnon-traumatic lower extremity amputations7,8
8/10 individuals with diabetes die from CV events6
•Burden of diabetes complications
Diabetes is a lifelong condition associated with serious complications
1. UKPDS Group. Diabetes Res 1990;13:1–11. 2. Fong DS et al. Diabetes Care 2003;26(Suppl. 1):S99–S102. 3. The Hypertension in Diabetes Study Group. J Hypertens 1993;11:309–317. 4. Molitch ME et al. Diabetes Care 2003;26(Suppl. 1):S94–S98. 5. Kannel WB et al. Am Heart J 1990;120:672–676. 6. Gray RP & Yudkin JS. Cardiovascular disease in diabetes mellitus. In Textbook of Diabetes 2nd Edition, 1997. Blackwell Sciences. 7. King’s Fund. Counting the cost. The real impact of non-insulin dependent diabetes. London: British Diabetic Association, 1996. 8. Mayfield JA et al. Diabetes Care 2003;26(Suppl. 1):S78–S79
•Burden of diabetes complications
Individuals with diabetes are at increased risk of cardiovascular mortality
1. Adapted from: Lotufo P et al. Arch Intern Med 2001;161:242–247
Age-adjusted relative risk of death compared with men with no diabetes or CHD
Rela
tive
risk
of d
eath
•Burden of diabetes complications
Diabetes is a leading cause of death worldwide
Diabetes is the fifth leading cause of death after communicable diseases, cardiovascular disease, cancer and injuries
1. Roglic G et al. Diabetes Care 2005;28:2130–2135
All-c
ause
dea
ths
attrib
utab
le
to d
iabe
tes
(%)
•Association with major psychological distress/quality of life
The physical, psychologicaland social effects of diabetes are inter-related
1. Polonsky WH. Diabetes Spectrum 2000;13:36–41
Physical Psychological & emotional
Social
Long-term complications:vision loss, kidney damage,heart disease, amputationShort-term complications:fatigue, sleep disturbance, infections, weight gainSymptoms:glucose control (HbA1c),hypo-/hyperglycemia & lifestyle changes
• Depression• Anger • Fear• Persistent fatigue• Exhaustion• Helplessness • Chronic frustration
Changes in daily habitsRelationships with family/friends sufferSocial life affected
•The burden of diabetes on healthcare systems
In the US, cost of a person with diabetesis 2.4 higher than cost of a person without diabetes*
• Cost of diabetes in the US in 2002: $132 billion• Direct and indirect costs: $91.8 and $39.8 billion, respectively
*Compared with a non-diabetic individual: adjusted for age, sex, race/ethnicity1. Hogan P et al. Diabetes Care 2003;26:917−932
Distribution of total direct healthcare costs
•The burden of diabetes on healthcare systems
High direct and indirect cost ofdiabetes in Latin America and the Caribbean
• Estimated costs in 25 countries:– Direct costs: $11 billion (18%)– Indirect costs: $54 billion (82%)
1. Barcelo A et al. Bulletin of the World Health Organization 2003;81:19–27
Distribution of total direct healthcare cost
Contributors to the costs of diabetic complications
Diabetesmedications
44%
Complications24%
Consultations23%
Hospitalization9%
Nephropathy74%
Neuropathy3%
PeripheralVascular
Disease 2%
Cardiovascular Disease 10%
Retinopathy 11%
All costs are in year 2000 US$ values
•The burden of diabetes on healthcare systems
High cost of T2DM in Europe: CODE-2 Study
• Direct medical costs: €29 billion per year
1. Jonsson B. Diabetologia 2002;45:S5–S12
Distribution of overall costs for T2DM patients
Ambulatory, 18%
Other drugs21%Hospitalization
54%
Cardiovascular and lipid lowering, 42%
Anti-infectives2%
OHAs 13%
Insulin11%
All others 26%
Distribution of overall drug costs for T2DM patients
Costs expressed in 1999 values
Antidiabetic drugs, 7%
Gastrointestinal 6%
•The burden of diabetes on healthcare systems
Complications and hospitalizationssubstantially increase the cost of diabetes
• In patients with both micro and macrovascular complications: – The average cost per patient is increased 3.5-fold – Hospitalization costs are increased 5.5-fold
1. Williams R et al. Diabetologia 2002;45:S13–S17
1.7 x 2.0 x
3.5 x
2.1 x
3.1 x
5.5 x
Effect of complications on the average cost per patient
Effect of complications on hospitalization costs
Cost
impa
ct fa
ctor
Cost
impa
ct fa
ctor
•The burden of diabetes on healthcare systems
Cost of diabetes represents asignificant share of healthcare resources
Medical expenditures for people with diabetes are
2–3 times higher than those without diabetes1
• Costs increase with progression of complications2
• Diabetes costs represent a significant share of total healthcare expenditures per country:*
– Italy: 6.6%, Germany: 6.5%, Netherlands: 1.6%3
– US: 11%4
– Taiwan: 11.5%5
– Israel: 6.9% (HMO budget; MHS)6
*Costs attributable to diabetes – Costs incurred by people with diabetes would represent a higher percentage; e.g. 19% for USMHS: Maccabi Healthcare Services1. Rubin RJ et al. J Clin Endocrinol Metab 1994;78:809A−809F 2. Brown JB et al. Arch Intern Med 1999;159:1873−18803. Jonsson B et al. Diabetologia 2002;45:S5−S124. Hogan P et al. Diabetes Care 2003;26:917−9325. Lin T et al. Diabetes Res Clin Pract 2001;54(Suppl 1):43−466. Chodick G et al. Eur J Health Econ 2005;Vol 6(2):166−171
Burden of diabetes – summary (1)
• Diabetes is an increasing epidemic worldwide:1
– By 2030 the number of people with diabetes globally will exceed 438 million1
– In developing countries, it will affect people aged 45−65 years1
• Diabetes is a lifelong condition with devastating consequences:– 8/10 persons with diabetes die from CV events4
– The leading cause of blindness in adults2,3
– The fifth leading cause of death worldwide5
– A disease associated with major psychological distress6 – A reduced quality of life7
1. Wild S et al. Diabetes Care 2004;27(5):1047–1053 2. UKPDS Group. Diabetes Res 1990;13:1–11. 3. Fong DS et al. Diabetes Care 2003;26(Suppl. 1):S99–S1024. Gray RP & Yudkin JS. Textbook of Diabetes 2nd Edition, 1997. Blackwell Sciences 5. Roglic G et al. Diabetes Care 2005;28:2130–21356. Skovlund S et al. Diabetes Spectrum 2005;18:136–1427. Koopmanschap M. Diabetologia 2002;45:S18–S22
Burden of diabetes – summary (2)
• An increasing burden on healthcare systems: – Medical expenditures for people with diabetes are 2–3 times higher than those
without diabetes1
– Diabetes costs represent a significant share of total healthcare expenditures per country
– Costs increase with progression of complications2
• Worsening glycemic control results in substantial cost increases:– For each 1% increase in HbA1c above 6%, the costs of diabetes increase by
approximately 4, 10, 20 and 30%3
• Costs of lost production are at least as high as direct costs1
1. http://www.eatlas.idf.org/Costs_of_diabetes/ Last accessed 121206 – Diabetes Atlas second edition – IDF2. Brown JB et al. Arch Intern Med 1999;159:1873−18803. Gilmer et al. Diabetes Care 1997;20(12):1847–1853