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

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Developed Countries Developing Countries

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• 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

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dea

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attrib

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(%)

•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

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Cost

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•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