arizona's diabetes crisis: today and future trends - greater detroit
TRANSCRIPT
Michigan’s Diabetes Crisis: Today
and Future Trends
Dr. William Rowley
Institute for Alternative Futures
1
During their lifetimes:
1/2 will become obese
1 in 3 males & 2 in 5
females will get diabetes
Earlier disability
Life expectancy 2-5 years
What’s Happening to Our Children?
2
Wang. Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic, Obesity, 2008;16:2323-2330; Hannon, Tamara, et.al., Childhood Obesity and Type 2 Diabetes Mellitus, Pediatrics Vol. 116 No. 2 August 1, 2005 pp. 473 -480 Narayan, Lifetime Risk for Diabetes Mellitus in the United States, JAMA 2003;290:1884-1890; Population Reference Bureau. Will Rising Childhood Obesity Decrease U.S. Life Expectancy? Accessed 3/25/11. http://www.prb.org/Articles/2005/WillRisingChildhoodObesityDecreaseUSLifeExpectancy.aspx.
Increasing Prevalence of Obesity
20-24% 25-29% 35-39% 30-34% 40-44% 50-54% 45-49% 15-19% 10-14% <10% 55-60% >60%
1990 2005
Adults over 20 y/o
2015
Obesity Health costs for MI = 30B/yr
2030
No Data
Michigan Statistics
3
56% 45%
Sources: CDC Behavioral Risk Factor Surveillance System; Wang & Beydoun, The Obesity Epidemic in the United States – Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systemic Review and Meta-Regression Analysis. Epidemiol Rev 2007;29:6-28; Wang Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic. Obesity 2008;16:2323-2330; Translation of national data to state data by the Institute for Alternative Futures.
28%
Diagnosed Diabetes Projections
4
0
10
20
30
40
50
60
70
2000 2010 2020 2030 2040 2050
Pre
vale
nce i
n M
illi
on
s
CDC 2001 CDC 2003 CDC 2006 CDC 2010
CDC 2001 = Boyle, et al. Projection of Diabetes Burden Through 2050, Diabetes Care 2001;24:1936-1940 CDC 2003 = Honeycutt, A Dynamic Markov Model for Forecasting Diabetes Prevalence in the United States Through 2050, Health Care Manag Sci 2003;6:155-164 CDC 2006 = Narayan, Impact of Recent Increase in Incidence on Future Diabetes Burden, Diabetes Care 2006;29:2114-2116 CDC 2010 = Boyle, Projection of the year 2050 burden of diabetes in the US adult population, Population Health Metrics ,2010, http://www.pophealthmetrics.com/content/8/1/29
Progression of Diabetes
5
Percent of Total Population with Diabetes
6-7% 10-11% 18-19% 12-13% <6% 16-17% 8-9% 14-15%
2000 diabetes prevalence by state map - CDC Behavioral Risk Factor Surveillance System prevalence of diabetes maps, http://www.cdc.gov/diabetes/statistics/maps/; 2010, 2015 & 2025 – IAF Diabetes 2025 Model http://www.altfutures.org/diabetes2025 utilizing latest national projections from Boyle, Projection of the year 2050 burden of diabetes in the US adult population, Population Health Metrics ,2010, http://www.pophealthmetrics.com/content/8/1/29
2000 2010
2015 2025
Increasing Prevalence
6.3%
12.8% 15.3%
11.2%
39.7 M 53.1 M
17.5 M 32.3 M
Improvements in therapies and medical management over time are factored in
Progression of Diabetes
*Constant 2010 Dollars
Total Annual Direct Medical and Indirect Societal Costs of Diabetes in Billions of Dollars*
25+ <1 3-4.9 5-9.9 15-24.9 1-2.9 10-14.9
$64B
$52B $40B
$28B
$37B
$30B
$36B
2010
2015 2025
Increasing Annual Diabetes Cost in $ Billions*
Entire US:
$374B
Entire US:
$299B
Entire US:
$514B
$46B
$27B
6
IAF Diabetes 2025 Model http://www.altfutures.org/diabetes2025 utilizing cost estimates by: Zhang Y. Medical Costs Associated with Prediabetes. Population Health Management. 2009; 12(2):157-163; Zhang Y, et al. Economic Costs of Undiagnosed Diabetes. Population Health Management. 2009; 12(2):95-101; Dall TM, et al. Distinguishing the Economic Costs Associated with Type 1 and Type 2 Diabetes. Population Health Management. 2009; 12(2):103-110.
$13B
$11B
$16B
2000 2010 2025
Total Diabetes 625,800 1,156,300 1,639,900
Pre-diabetes 1,452,700 2,629,600 2,728,800
Annual Cost $4.8B* $10.6B $15.8B
Increasing Prevalence of Diabetes
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DIABETES IN MICHIGAN
* Cost of diagnosed diabetes only
Rowley W, Bezold C. Creating Public Awareness: State Diabetes Forecasts. Publication Health Management, accepted for publication. This study utilizes a national diabetes model by Boyle, Projection of the year 2050 burden of diabetes in the US adult population, Population Health Metrics ,2010, http://www.pophealthmetrics.com/content/8/1/29; US Census Bureau population estimates; latest CDC national diabetes statistics and state prevalence rates.
Increasing Prevalence of Diabetes
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1,770
New Kidney Failure
2,300
New Amputations
DIABETES COMPLICATIONS IN MICHIGAN
131,800
Total Visual Impairment
Rowley W, Bezold C. Creating Public Awareness: State Diabetes Forecasts. Publication Health Management, accepted for publication. This study utilizes a national diabetes model by Boyle, Projection of the year 2050 burden of diabetes in the US adult population, Population Health Metrics ,2010, http://www.pophealthmetrics.com/content/8/1/29; US Census Bureau population estimates; latest CDC national diabetes statistics and state prevalence rates.
Michigan: Race and Hispanic Origin
9
HISPANIC AMERICANS AFRICAN AMERICANS NATIVE AMERICANS
*Compared to non-Hispanic Whites
• 50,600 cases of diabetes
• 90% greater risk of
developing diabetes*
• 70% greater risk of renal
failure*
• 50% greater risk of dying
from diabetes*
• 7,600 cases of diabetes
• Twice as likely to be
diagnosed with diabetes*
• Over twice the risk of
renal failure &
amputations*
• Life span shortened
13-17 years
• 216,300 cases of
diabetes
• Twice as likely to be
diagnosed with diabetes*
• Almost twice as likely to
die from diabetes*
Rowley W, Bezold C. Creating Public Awareness: State Diabetes Forecasts. Publication Health Management, accepted for publication. This study utilizes a national diabetes model by Boyle, Projection of the year 2050 burden of diabetes in the US adult population, Population Health Metrics ,2010, http://www.pophealthmetrics.com/content/8/1/29; US Census Bureau population estimates; latest CDC national diabetes statistics and state prevalence rates.
Increasing Prevalence of Diabetes
10
*Cost of diagnosed diabetes only
Diabetes Data & Forecasts. 2025 Diabetes Forecasts for State and Metropolitan Areas Study by the Institute for Alternative Futures. This study utilizes: a
national model from Narayan. Impact of Recent Increase in Incidence on Future Diabetes Burden. Diabetes Care 2006, 29:2114-2116; the latest CDC
projections by Boyle; US Census Bureau population estimates; and latest CDC national diabetes statistics and state prevalence rates.
2000 2010 2025
Total Diabetes 288,900 512,000 703,000
Pre-diabetes 649,400 1,131,700 1,130,100
Annual Cost $2.2 B* $4.7 B $6.8 B
DIABETES IN METRO DETROIT
Diabetes and America's Seniors
12
Medicare pays for screening, but early
on only 10% utilized it
65 and older 1,334,500
Known diabetes 262,100
Undiagnosed diabetes 96,900
Pre-diabetes 667,200
Must find these: 764,100
SENIOR POPULATION IN MICHIGAN
Centers for Disease Control and Prevention, National Diabetes Fact Sheet, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf; Institute for Alternative Futures Diabetes 2025 Methodology, http://www.altfutures.org/diabetes2025; Ask.Screen.Know. Brochure.
Screening
• If 50% with prediabetes
made these lifestyle
changes, 330,000 fewer
people would develop
diabetes a year
(~4,700,000 by 2025)
• 12,000,000 have
undiagnosed diabetes
• May already be causing
organ damage
13
Diabetes Prevention Program:
Lifestyle modification reduced
incidence of diabetes 58%
(71% seniors aged 60+) - 3 year
follow-up • 30 minutes of physical activity
5 days a week
• At least a 7% weight loss
Rowley W, Bezold C. Creating Public Awareness: State Diabetes Forecasts. Publication Health Management, accepted for publication. This study utilizes a national diabetes model by Boyle, Projection of the year 2050 burden of diabetes in the US adult population, Population Health Metrics ,2010, http://www.pophealthmetrics.com/content/8/1/29; US Census Bureau population estimates; latest CDC national diabetes statistics and state prevalence rates; ; Diabetes Prevention Program Research Group, Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403.
79,000,000 Americans Have Pre-diabetes
Impact of Effective Management
• Effective management can lower decline of renal function
by 30-70%
› If 50% with diabetes complied with effective
management it could prevent 15,000 cases of renal
failure a year
15
Rowley W, Bezold C. Creating Public Awareness: State Diabetes Forecasts. Publication Health Management, accepted for publication. This study utilizes a national diabetes model by Boyle, Projection of the year 2050 burden of diabetes in the US adult population, Population Health Metrics ,2010, http://www.pophealthmetrics.com/content/8/1/29; US Census Bureau population estimates; latest CDC national diabetes statistics and state prevalence rates.
Asheville Project
• Sponsored by employer – an investment
• Employees with diabetes volunteer
• Receive additional diabetes education
• Lab, glucometer, meds – no co-pays
• Meet with trained pharmacist
• Collaboration with doctor
16
PATIENT SELF-MANAGEMENT PROGRAM
Cranor, Bunting & Christensen, The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program, Am Pharm Assoc 2003;43:174-184.
Asheville Project
17
0
2
4
6
8
0
50
100
150
Avg. Glycosylated Hemoglobin LDL Cholesterol
6.7 95
7.6 121
0
5
10
15
6.01
12.61
Total Individual Diabetes Medical Costs
$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000 58%
Savings $4,651
$7,248
$6,127
Results at 5 Years
Avg. Ann. Diabetic Sick-Leave
Cranor, Bunting & Christensen, The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program, Am Pharm Assoc 2003;43:174-184.
A Patient-Centered Medical Home
18
Accountable
team leader Continuity of care
using evidence-
based medicine
Collaborative
team of
providers
Ongoing
Monitoring
& support
Electronic
records
Global payment with
incentives for outcomes
Life-long continuity
of care
Easy access to care
Navigation,
Education
& coaching
Shared
decision-
making Entire health system of
specialty care services
What can be done?
19
Prevention Even if 50% of those with pre-diabetes
dramatically changed their lifestyles starting now
there would still be 48,400,000 people with
diabetes in America in 2025
The only realistic solution is preventing
pre-diabetes in the first place
Rowley W, Bezold C. Creating Public Awareness: State Diabetes Forecasts. Publication Health Management, accepted for publication. This study utilizes a national diabetes model by Boyle, Projection of the year 2050 burden of diabetes in the US adult population, Population Health Metrics ,2010, http://www.pophealthmetrics.com/content/8/1/29; US Census Bureau population estimates; latest CDC national diabetes statistics and state prevalence rates.
0%
20%
40%
60%
80%
Don't Smoke
Maintain
Healthy
Wt.
Eat 5
F&V/d
Exercise
5X30
Do all 4
3%
Preventing Diabetes
20 Reeves, Healthy Lifestyle Characteristics Among Adults in the United States, 2000, Arch Intern Med, 2005
Healthy Lifestyles
Preventing Diabetes
21
Crowley & Lodge, Younger Next Year, Workman Publishing Company, 2004; Diabetes Prevention Program Research Group, Reduction in the incidence
of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403; NDIC. Diabetes Prevention Program. Accessed 3/25/11.
http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/; Ford, Healthy Living is the Best Revenge: Findings from the European Prospective
Investigation into Cancer and Nutrition, Arch Intern Med 2009;169:1355-1362
Seniors who exercise 30 minutes 5 days a week
and lose 7-15 pounds can prevent pre-diabetes
from becoming diabetes by 71%
70% of premature death is lifestyle-related
50% of all illness & injuries in the last third of life
can be eliminated by changing lifestyle
Healthy lifestyle can reduce cancer risk 36%,
diabetes risk 93%, heart attack by 81%
Dramatic Change in Our Food
Calories
Fat
(g)
Sat Fat
(g)
Carb
(g)
Protein
(g)
Sodium
(mg)
Commercial
Burrito 1,174 60 23 142 52 2,295
Tarahumara
Burrito 215 5 0.6 14 29 170
23 Daphne Miller, MD, The Jungle Effect, Harper Collins, NY, 2008.
Community Action
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EAT WELL – Eat Better Mindlessly
Plant Slant
Home gardens Healthy
school
lunches
Smaller plates
Daily
weight
Set up an environment in ways that make healthy
choices easy
AARP. The Minnesota Miracle. Accessed 3/25/11. http://www.aarp.org/health/longevity/info-01-2010/minnesota_miracle.html.
Community Action
GET MOVING – Throughout the Day
Finding a Purpose Community Connections
AARP. The Minnesota Miracle. Accessed 3/25/11. http://www.aarp.org/health/longevity/info-01-2010/minnesota_miracle.html.
Diabetes Burden on Workers
• If onset of diabetes at
age 40:
› Quality of life shortened
18-22 years
› Lifespan shortened
11-15 years
› 2-4 X risk dying of heart
disease
› Avg. cost of complications
$11,600/year*
*In 2010 dollars
26
Narayan, et al. Lifetime Risk for Diabetes Mellitus in the United States. JAMA 2003;290:1884-1890; CDC. Diabetes Fact Sheet, 2011. CDC
Web site. Accessed 1/27/11. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf; WebMD. Diabetes Complications Cost Billions.
Accessed 3/25/11. http://diabetes.webmd.com/news/20070410/diabetes-complications-cost-billions
Creating Healthy Employees
28
Financial Incentives
• $150 for health risk appraisal
• $20/mo for fitness center
• $14 per 1% weight lost
• $150 if quit smoking
• Redeemable points
Health Risk
Appraisal
• Customized to employee needs
• Measure return on investment
Advice
Nurse
Nutritional
Counseling
Online Support
Health
Education
Have a well designed wellness program
Jones AP et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation, Am J Public Health 2006; 96:488-494.
Diabetes in Counties
29
Percent with Diagnosed Diabetes
by County in 2007
CDC. County Level Estimates of Diagnosed Diabetes. Accessed 3/25/11. http://apps.nccd.cdc.gov/DDT_STRS2/nationaldiabetesprevalenceestimates.aspx?mode=DBT.
Normal Blood
Sugar
Diagnosed
Pre-diabetes
Diagnosed
Uncomplicated
Diabetes
Death Diagnosed
Complicated
Diabetes
Systems Dynamic Modeling of diabetes
30
Lifestyle
Changes
Risks of
diabetes
Control of Diabetes Clinical management, medications,
self-monitoring & compliance, healthy
lifestyles
Pre-diabetes Management Healthy lifestyles
Detection
Jones AP et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation, Am J Public Health 2006; 96:488-494.
Diabetes Prevalence
31
Jones AP et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation, Am J Public Health 2006; 96:488-
494.
What can be done to reduce the prevalence of diabetes?
Diabetes Prevalence
32
Clinical
management
ramped up from
48% in 2006 to 67%
in 2012 with no
further improvement
after that.
Jones AP et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation, Am J Public Health 2006; 96:488-
494.
What can be done to reduce the prevalence of diabetes?
Diabetes Prevalence
33
Ramp up
management of pre-
diabetes from 20%
in 2006 to 50% in
2012 with no further
improvement after
that.
Jones AP et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation, Am J Public Health 2006; 96:488-
494.
What can be done to reduce the prevalence of diabetes?
Diabetes Prevalence
34
Jones AP et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation, Am J Public Health 2006;
96:488-494.
What can be done to reduce the prevalence of diabetes?
Reducing Diabetes Related Deaths
35
Jones AP et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation, Am J Public Health 2006;
96:488-494.
What can be done for reducing deaths associated
with diabetes?
Challenges and Opportunities
• Diabetes is a rapidly growing societal burden for Michigan
• We know how to prevent and manage diabetes –
must reach everyone
• My advice:
› Health providers – screen & aggressively manage diabetes
› Public – be proactive and get tested
› Exercise 30 min × 5; eat 5 fruits & vegetables daily
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Research funded by Novo Nordisk, Inc.
For more information:
www.altfutures.org/diabetes2025
©2011 Novo Nordisk 144079 April 2011
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