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