systems dynamic modeling diabetes prevalence kenn b. daratha, phd diabetes network leadership team...

Systems Dynamic Modeling Diabetes Prevalence

Kenn B. Daratha, PhD

Diabetes Network Leadership Team Past-Chair

Representing Washington State University

Healthy People 2010

Goal: Through prevention programs, reduce the disease and economic burden of diabetes, and improve the quality of life for all persons who have or are at risk for diabetes

Source: http://www.healthypeople.gov/Document/HTML/Volume1/05Diabetes.htm#_Toc494509746

Healthy People 2010

Objectives

Education IncidencePrevalenceComplicationsControl

Source: http://www.healthypeople.gov/Document/HTML/Volume1/05Diabetes.htm#_Toc494509746

Healthy People 2010

Objectives 5-3

Reduce the overall rate of clinically diagnosed diabetes

Baseline 40 cases/1,000 populationTarget 25 cases/1,000 population

Source: http://www.healthypeople.gov/Document/HTML/Volume1/05Diabetes.htm#_Toc494509746

Systems Dynamic Modeling

Computer model simulations of diabetes population dynamics

Track rates of onset, diagnosis and deathAssess effects of interventions

Source: Milstein, 2007; Charting Plausible Future for Diabetes Prevalence in the U.S.

Systems Dynamic Modeling

POPULATION STOCK

Flow from one population stock to another

Systems Dynamic Modeling

Please think about the manner in which you might be able to control these flows

POPULATION STOCK

Flow from one population stock to another

Diabetes Prevalence

16.3% Obese = 95th Percentile (age/gender)

15.0% Overweight = 85th Percentile (age/gender)

Obesity in last 30 years Doubled (2-5 years) Tripled (6-11 years) Doubled (12-19 years)

HEALTHY YOUTH

Source: CDC NHANES 2003-2006

Diabetes Prevalence

16.3% Obese = 95th Percentile (age/gender)

15.0% Overweight = 85th Percentile (age/gender)

Obesity in last 30 years Doubled (2-5 years) Tripled (6-11 years) Doubled (12-19 years)

HEALTHY YOUTH

Source: CDC NHANES 2003-2006

Rate of Unhealthy Children Entering Adulthood

ADULTS NORMAL

GLYCEMIA

HEALTHY YOUTH

Diabetes Prevalence

Estimated to be 67% of adult population Function of obesity

33.3% of men BMI > 3035.3% of women BMI > 30

Source: CDC NHANES 2003-2006

ADULTS NORMAL

GLYCEMIA

HEALTHY YOUTH

Diabetes Prevalence

Estimated to be 67% of adult population Function of obesity

33.3% of men BMI > 3035.3% of women BMI > 30

Source: CDC NHANES 2003-2006

Rate of Obesity

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Estimated to be 25% of adult population Only area of the model allows movement

upstream

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Estimated to be 25% of adult population Only area of the model allows movement

upstream

Rate of Disease Onset

Rate of Recovery

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Estimated to be 2-3% of adult population Focus on detection

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Estimated to be 8% of adult population

Focus on management and control

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Estimated to be 8% of adult population

Focus on management and control

Rate of Detection

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Unhealthy Children Entering Adulthood

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Unhealthy Children Entering Adulthood Diabetes Prevalence

Rate of Unhealthy Children Entering Adulthood

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Obesity

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Obesity

Rate of Obesity Diabetes Prevalence

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Disease Onset

Rate of Recovery

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Disease Onset

Rate of Recovery

Rate of Recovery vs. Disease Onset Diabetes Prevalence

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Detection

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Detection

Rate of Detection Diabetes Prevalence

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Death

ADULTS NORMAL

GLYCEMIA

ADULTS PRE

DIABETES

ADULTS UNDX

DIABETES

ADULTS DX

DIABETES

HEALTHY YOUTH

Diabetes Prevalence

Rate of Death

Rate of Death Diabetes Prevalence

Diabetes Prevalence ScenariosTo

tal P

reva

lenc

e of

Dia

bete

s p

er 1

,000

Adu

lts

• Status quo• Basic diab

mgmt• PLUS

intensive diab mgmt

• PLUS basic pre-DM mgmt

• PLUS intensive pre-DM mgmt

• PLUS obesity reductions

200

150

100

50

0

1980 1990 2000 2010 2020 2030 2040 2050

Time (Year)Source: Model Runs DOH (Sitaker, 2009)

Closing Thought

Objectives 5-3

38% Reduction in the overall rate of clinically diagnosed diabetes?

Number of new cases > deaths Increased detection Decreased mortality

Source: Source: Milstein, 2007; Charting Plausible Future for Diabetes Prevalence in the U.S.