New forecast model
The prevention of diabetes is a growing global issue because of its increasing scope and changing nature. The simple division of type 1 being a childhood onset disease and type 2 being an old people’s disease is no longer adequate. Type 2 hits hard among people in the productive ages between 15 and 64 and among people in the developing world. Type 1 has been relatively unknown in the developing world until recently because people die before they are even diagnosed.
A particular problem is the fact that type 2 progresses in silence from no problem to severe disabilities due to lack of awareness, lack of proper life style and lack of treatment. In principle all people with diabetes could lead a full life, contributing to wealth and production without the risk of becoming disabled or being a burden to their families or to society. While such an ideal situation is indeed not realistic, a lot can be done to reduce the overall burden of the disease. Changing the current developments requires a better understanding of the underlying developments.
Together with Professor Anders Green2 Novo Nordisk has developed a new model forecasting the diabetes population to 2025. The forecasts are based on assumptions for population growth, age distribution and the current epidemiological state in a diabetes population (assumptions for incidence, prevalence, progression of complications and mortality). The model forecasts developments in different treatment scenarios over a 20-year period. The treatment scenarios are based on what happens in different futures such as if current trends in diabetes and treatment continue, if obesity increases, if better prevention and medical treatment or more screening etc. becomes available. The outcomes of these different scenarios can then be compared.
If the current treatment schemes in combination with current lifestyle impact continue, we will see an increasing diabetes burden. In 2025 the diabetes population will be larger than today and have more serious complications, resulting in a burden not only in healthcare costs but also in more people that are unable to support themselves and their families productively and with a lower quality of life.
Assuming increased obesity this development would be even stronger and the group of disabled people will increasingly be younger people, thus underlining the severity of the problem as the population in general is ageing.
The underlying idea is that the future can be impacted in a positive direction if the progression of the disease is impacted. Compared to a continuation of the current trends an improved scenario could lead to fewer people with diabetes with a much larger share in a good condition or even more people with diabetes but with fewer of them having complications.
Two examples of the type of outcome that the model can produce are presented. The consequences of future developments to 2025 of the current state. of diabetes in Denmark are based on epidemiology, medication and level of complications from 17,000 diabetes patients in Aarhus County. The alternative case is based on assumptions for increased incidence and progression of early complications due to increased obesity.
On the basis of the current state of diabetes the model estimates that the Danish population of people with diabetes will increase by 19% to 187,000 persons by 2025. In the alternative case where a higher level of obesity is assumed the increase is 28% to 201,000 people with diabetes. In the ‘current scenario’ the share of persons with heavy complications (comp2) will rise from 9% (14,800 people with diabetes) to 10% (19,000 people with diabetes) of all people with diabetes. In comparison the obesity case estimates an increase of heavy complications (comp2) to 10.6% (21,300 people with diabetes).
Other predictions could be to estimate what will happen in scenarios with better treatment, more insulin etc. These estimates are based on an assumption that could impact the incidence and prevalence rates, disease progression rates, mortality rates through improved awareness of lifestyle impacts as well as improved treatment.
