Present methodology and ask for

1
Disability Adjusted Life Year (DALY) from
Diabetes Mellitus in the year 2004
DALY YLL YLD (??? ????)
Today, focus on YLD due to Diabetes in Thai
population
Diabetes criteria case and sequelae
1. Case elevated blood glucose or
hyperglycaemia 2. Sequelae Retinopathy,
Cataract, Glaucoma, Neuropathy, Nephropathy,
Amputation-toe, Amputation-foot or leg
2
We are looking for data quality that need to be
input in DISMOD program prevalence,
incidence, duration, age onset in Thai
population Disability weight YLD in
Thai population I x Dw x L I incidence Dw
Disability weight L Duration of disability in
years
Data input 1. Prevalence or Incidence 2.
Remission rate 3. Mortality rate or Fatality
rate
3
Disability weights GBD Dutch
Full health
0
eczema
mild heart failure 0.06
uncomplicated diabetes
mild-moderate angina 0.08
mild depression
0.2
ankle fracture
moderate heart failure 0.35
0.4
severe vision loss
Acute myocardial infarction (treated) 0.395
Acute myocardial infarction (untreated) 0.491
burns gt 20 body surface
AIDS
severe angina 0.57
0.6
moderate stroke 0.63
severe heart failure 0.65
severe depression
0.8
severe stroke 0.92
severe dementia
1
Worst possible health
4
1 Case
Diabetes mellitus is defined as a group of
metabolic diseases or elevated blood glucose
(hyperglycaemia). WHO classification of
hyperglycemia into Type 1 / Type 2 / Other
specific types of diabetes / Gestational diabetes
Input data 1. Prevalence from NHES III (2004) 2.
Remission rate 0 3. Fatality rate 4. Disability
weight 0.012 untreated group 0.033 treated
group
5
Table DM prevalence form the NHES III (2004),
first report male female 15-29 2 2 30-44 5 5 45
-59 11 13 60-69 14 19 70-79 12 16 80 16 9 Tot
al 6 7
This study used hyperglycaemia prevalence from
Thai NHES III (2004). Criteria for hyperglycaemai
was fasting plasma glucosegt 126 mg/dL with
positive medical diagnosis.
Prevalence used in 1999
6
Dm self report from NHES III (2004) treat
treat untreated control
uncont Male 15-29 0 0 0 30-44
4 22 2 45-59 9
28 3 60-69 15 35 2 70-79 17
30 2 80 18 16 1 total 9
24 2 Female 15-29 1
14 0 30-44 4 31 2 45-59 19
38 1 60-69 22 38 3 70-79
23 36 2 80 14 22 4 total
15 24 2
"Inter Asia 2000" study documented the proportion
of diagnosed (treated case) and undiagnosed
(untreated case) DM among their 5,000 sample aged
between 35-65 in Chaing Mai, Hat yai, Khon khan,
BKK, Supan (1,000 sample in each province)
??????????????? NHES III ?????????????????? 1
?????????? ??????????????????? ??????? treat
uncontrol / untreat ????????????????????????????
? Inter Asia ??????
7
IDDM estimation used BOD last study The
Diabcare-Asia study 1998 which examined 2568
diabetics from DM clinics across the country.
They found 3.8 of cases to be IDDM. As the
community survey figures for DM include half of
cases which have not yet been diagnosed we assume
that in a community sample IDDM would be half
that proportion 2. This translates into a
prevalence across all ages of 22.9 0.058 in
males and 23.90.078 in females. We also
assume no remission and similar RR of dying as in
NIDDM. We then subtract the IDDM incidence (at
ages 15 and above) from the overall DM incidence
figures to get the NIDDM figures.
?????????? ??? ??????????????????????
??????????????? ?? 2547 ????? ??? Incidence ????
??? prevalence ?????????
8
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9
Sequelae Proliferative Diabetic Retinopathy
Input data 1. Prevalence from the Newcastle
study (10 years followed from 1977), by assuming
66 moderate sight impairment and 33
severe sight impairment Reference NHMRC in
Victoria study 2. Disability weight 0.017 for
moderate sight impairment 0.430 for severe
sight impairment
10
Thai BOD 1999, used the Newcastle study
(diabetics followed for 10 years from 1977) on
the prevalence of PDR by known duration of
diabetes.
Known duration Prevalence of PDR of DM
(Years) IDDM NIDDM lt 5 0 0 5-9
0 0 10-14 3.8 8.8 15-19 20
8.8 20-29 27 18 30 42
26
Diabetes Registry Project 2003 reported diabetic
complication (Retinopathy) 30.7 (N9,419)
11
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Sequelae Diabetic Cataract
Input data 1. Estimate proportion of
cataract-related blindness attributable to
diabetes by using RR of gt 4.0 for ages lt59,
gt 3.0 for ages 60-69 and gt 2.0 for ages 70
to estimate proportion. NHMRC (1997) reviewed
population data from Framingham Eye Survey, US
National Health and Nutrition Examination Survey,
Blue Moutnains Eye Study (1992-94) and Melbourne
Visual Impairment project. Both US studies gave a
relative risk of cataracts of 4.02 for people
aged less than 65, and NHANES but not Framingham
also found a significant relative risk (1.63) for
people aged 65 years and over.
13
case ??? DRG ????????????????? ???????????????????
???????
1999 2004 Males 0-4 0 38 5-14 0 140 1
5-29 0 5,447 30-44 1,259 9,419 45-59 14,920
10,185 60-69 26,178 10,142 70-79 19,317 6,
950 80 4,919 2,376 Total 66,593 44,698
Females 0-4 0 39 5-14 0 110 15-29 0 3,
410 30-44 2,050 6,987 45-59 30,940 14,096 6
0-69 41,264 13,446 70-79 30,804 9,643 80 8
,461 3,622 Total 113,518 51,353
Diabetes Registry Project 2003 reported diabetic
complication (Cataract) 42.8
(N9,419)
14
Prevalence case cataract attributable to
diabetes Total pop IDDM NIDDM IDDM NIDDM Total
Male 0-4 2,067,927 12 - 0.0 0.0 0.0
5-14 4,974,780 960 - 0.1 0.0 0.1 15-29 7,857,
277 5,516 136,940 0.2 5.0 5.2 30-44 8,040,723
8,273 424,831 0.3 13.7 14.0 45-59 4,812,852
4,982 477,951 0.3 23.0 23.3 60-69 1,736,560 1
,742 236,575 0.2 29.0 29.2 70-79 897,641 689
122,664 0.1 21.5 21.5 80 303,193 141 46,84
4 0.0 13.4 13.4 All 30,690,953 22,315 1,445,8
05 Female 0-4 1,943,009 12 - 0.0 0.
0 0.0 5-14 4,694,727 914 - 0.1 0.0 0.1 15-
29 7,619,207 5,563 133,695 0.2 5.0 5.2 30-44
8,269,331 8,765 441,320 0.3 13.8 14.1 45-59 5
,154,730 5,432 594,802 0.3 25.7 26.0 60-69 1,
981,501 1,967 363,770 0.3 35.5 35.8 70-79 1,1
48,604 784 205,950 0.1 26.4 26.5 80 454,938
188 53,967 0.0 10.6 10.6 All 31,266,046 2362
5 1,793,504
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16
Sequelae Diabetic Glaucoma
Mitchell (1997) found a two-fold increase in the
prevalence of glaucoma in diabetics and those
with high fasting blood glucose (OR 2.12 95 CI
1.18-3.79) in the BMES. Suggest to use a RR of 2
to calculate the glaucoma burden attributable to
diabetes.
DRG data underestimate..????
17
Sequelae Peripheral Neuropathy
Input data 1. Prevalence from the Colagiuri et
al (1998) have reviewed information on
prevalence, incidence and severity of peripheral
neuropathy in diabetes. In Australia, 25 of
diabetics are estimated to have peripheral
neuropathy. It is present in 8 of new diagnoses
and in 50 of patients after 10 years. 2.
Remission rate 0 3. Fatality rate 4. Disability
weight 0.19
18
Assumptions using in the Victoria study, with
the best estimates coming from a rural WA study
in Australia concluded over 15 years ago (McCarty
et al 1996). This study estimated prevalence of
sensory neuropathy at 15.5 and 18.2 of males
and females with NIDDM and 7.7 and 8.9 of males
and females with IDDM. Assuming that 1. in
NIDDM at onset 20 x 8 1.6 have disability
from neuropathy and after 10 years 20 x 50
10 2. that the prevalence in IDDM is half
that in NIDDM 3. that the onset in IDDM is 10
years later
Prevalence of neuropathy Sex
IDDM NIDDM after 10 yrs after 20 yrs after
10 yrs after 20 yrs Male 0.8 5.0 1.6 10.0
Female 0.8 5.0 1.6 10.0
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20
Sequelae Diabetic Amputation
Input data 1. Diabetic amputation from DRG data
base 2. Assume that amputations on average
occur 20 years after onset of IDDM and on average
10 years after onset of NIDDM. 3. Disability
weight 0.064 for toe amputations 0.300
for foot/leg amputations
21
2004 IDDM NIDDM Toe Hip/foot/ Toe Hip/foot/
below knee below knee 0-14 0 0 0 1 15-29 0 0 1
31 30-44 2 0 31 96 45-59 17 23 149 93 60-69 25
2 149 38 70-79 3 1 98 10 80 0 0 26 0 47 26 45
4 269 0-14 0 0 2 0 15-29 0 0 2 25 30-44 4
0 62 97 45-59 30 24 197 98 60-69 16 12 227 111
70-79 4 1 136 28 80 0 0 25 0 54 37 651 359
Diabetes Registry Project 2003 reported diabetic
complication (Amputation) 1.6 (N9,419)
22
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23
Sequelae Nephropathy
Disease Sequelae Definition Diabetic
End-stage renal Excluding diabetic nephropathy
failure nephropathy and nephropathy due
to with dialysis cancers, congenital
conditions and injury End-stage
renal Excluding diabetic nephropathy and
failure with nephropathy due to cancers,
transplant congenital conditions, and
injury Transplanted Patients with
functioning transplant patient
Untreated Excluding diabetic nephropathy and
end-stage nephropathy due to cancers,
renal failure congenital
conditions, and injury
24
Sequelae Weight Comment End-stage renal
0.290 Dutchdisability weight failure with
dialysis for diabetic nephropathy First
half year after 0.290 Dutch disability weight
for transplant diabetic nephropathy Beyond
first half 0.110 GBD weight for treated with
transplant renal failure Dutch
weight for uncertain prognosis Untreate
d 0.104 GBD weight for untreated renal
end-stage failure (assumed to last 1
year) renal failure
25
1. Total nephritis and nephrosis from BOD
Study gt ESRD End stage renal failure with
dialysis gt ESRF End stage renal failure 2.
estimate incidence around 30 ESRF due to diabetes
Diabetes Registry Project 2003 reported diabetic
complication (Nephropathy) 43.9
(N9,419)
26
ESRD Kidney transplant Untreated ESRF ESRF from
Diabetes Males 0-4 - 0 14 0.0 5-14 -
0 0 0.0 15-24 209 14 0 0.0 25-34 - 30
154 28.9 35-44 417 80 0 26.6 45-54 1,2
52 58 0 29.5 55-64 1,148 33 0 33.4 65-7
4 1,461 6 0 27.7 75 313 0 0 53.7 Tota
l 4,800 221 168 29.9 Females 0-4 -
0 0 0.0 5-14 - 3 0 0.0 15-24 55 8 79
0.0 25-34 165 19 43 10.3 35-44 220 50
14 15.5 45-54 330 17 65 42.8 55-64 879
36 8 44.9 65-74 604 0 63 21.5 75 165
0 76 38.6 Total 2,417 132 6,116 31.1

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outline

• Introduction
• Definition sequelae
• Data input casesHigh blood sugar, amputation,
  retinopathy, nephropathy, cataract, cvd(?)
• Compare different sources of information DRG
  data
• Results (graph)
• Issues proportion of complication from DM

29
Present methodology and ask for

• Show NHESIII prevalence data
• Show dm control data from NHESIII
• RR mortality discussion from 2 studies
• Asking for sequelae data (retinopathy,
  neuropathy, nephropathy, amputation)
• permission that will start after defence thesis
  in October