European Commission - Public Health: healthindicators.org

Diabetes

Definition of indicator

Proportion of persons with (any types of) diabetes.

Diabetes (diabetes mellitus) is a metabolic disorder causing chronically increased levels of glucose in the blood. Complex metabolic changes lead to damage of many organs. Most common complications include blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. There are three main types of diabetes. Type 1 is diagnosed early in life and is due to decrease in insulin production. Type 2 diabetes is the most common form and is due to the development of insuline resistance. Gestational diabetes occurs during the pregnancy.

Calculation (numerator, denominator)

(1) Proportion of individuals reporting to have been diagnosed with diabetes which occurred during the past 12 months, derived from EHIS questions HS.4/5/6:

HS.4: Do you have or have you ever had any of the following diseases or conditions? (11. Diabetes) (yes / no)

If yes:

HS.5: Was this disease/condition diagnosed by a medical doctor? (yes / no)

HS.6: Have you had this disease/condition in the past 12 months? (yes / no)

(2) EUDIP/BIRO: Prevalence of diabetes mellitus per 1.000 population / Prevalence of persons with impaired glucose tolerance (, i.e. including previously unknown diabetes) and/or diet only, derived from HES.

(3) WHO: Cumulative number of patients with diabetes (ICD-10: E10-E14) at the end of the calendar year.

Additional underlying concepts

Relevant dimensions (subgroups)

Country (also region), calendar year, gender, age group.

Preferred data sources

(1) (E)HIS,

(2) national HES

(3) WHO, based on a combination of primary care registers, national statistics, hospital discharges, surveys.

Rationale

Diabetes has become one of the most important public health challenges of the 21st century. Diabetes can be treated and partly prevented.The epidemic of diabetes requires resources to be devoted to the management of diabetes and its complications. Diabetes is the leading cause of blindness in industrialised countries in people ages 20-74 and one of the most common cause of end-stage renal disease. Comparisons on international and regional level can serve as benchmark to identify gaps in health care.

Data availability, quality and periodicity

(1) EHIS implemented 2007/2009. Data will thus be available in the coming years (and will be pooled by Eurostat).

(2) EUCID project: prevalence data for 19 countries in 2004, 2005 or 2006. The indicators for the EUCID project were established by the European Diabetes Indicators Project (EUDIP).

(3) WHO: Data series for less than half of EU. Data come from a great variety of sources (National diabetes register, Routine reporting system, Hospital discharges, Surveys) and are considered not comparable.

Eurostat has hospital discharge data, and mortality due to diabetes mellitus.

Different definitions give vastly different estimates because they mean different things.

References

- WHO-HFA

- BIRO

- EUropean Diabetes Indicators Project, EUDIP (2000-2)

- EUropean Core Indicators in Diabetes, EUCID (2006-8)

- EUCID final report

- EPIC ELDERLY NAH

- WHO diagnostic criteria for diabetes mellitus or its preliminary stages (IGT and IFG); Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva, Switzerland: World Health Organization, 2006.

- EHIS standard questionnaire (version of 11/2006)

- The EUPHIX (European Union Public Health Information & Knowledge System, www.euphix.org); the Health Status chapter dedicates a topic on diabetes among Diseases, disorders, injuries / Other non-communicable diseases

Work to do

• Decide which definition, calculation method (source) to follow, EHIS ?
• Projects to follow: EUDIP/European Core Indicators for Diabetes Mellitus, BIRO, EUCID

More indicator information will follow in due time.