Health

Diabetes accounts for about 3.8 million deaths per year worldwide—of the same magnitude as deaths due to HIV/AIDs. The International Diabetes Federation says diabetes is “fast becoming the epidemic of the 21st century.”¹

Globally, it is estimated that more than 250 million people suffer from diabetes; this number is expected to jump to 380 million within 20 years, if nothing is done.² An estimated 308 million people have an impaired glucose tolerance—a potential precursor to diabetes. This number is projected to reach 418 million by 2025.³

Diabetes has also shifted down a generation—from a disease of the elderly to one that affects those of working age or younger. According to the International Diabetes Federation, type 2 diabetes in children is becoming a global public health issue.⁴

Canada has the third-highest rate of mortality due to diabetes among its peer countries, giving it a “C” rating. The most recent year of published data on mortality due to diabetes for Canada is 2004, with 18 deaths per 100,000 population. That rises to an estimated 19 deaths per 100,000 population in 2005 and 2006.⁵ Austria is the worst performer, at 26 deaths per 100,000 population.

These high mortality rates throw a spotlight on Japan, which has a very low rate of 5.5 deaths per 100,000 population.

Canada earned “C”s in the 1960s and 1970s, because of its relatively high incidence of mortality due to diabetes. By contrast, Denmark, Japan, Norway, and the U.K. were “A” performers then.

In the 1980s, Canada’s ranking improved to a “B,” but Finland, France, Ireland, and Sweden surpassed Canada’s improvements and joined the roster of “A” performers.

Canada’s grade slipped to a “C” in the 1990s and a “D” in the most recent decade, although it has since edged back up to a “C” in 2006. Austria, the U.S., and Italy have also been pushed to the back of this class on this indicator.

The three countries with solid “A”s throughout the five decades are Japan, Norway, and the United Kingdom.

Since the early 1980s, deaths from diabetes have gone up in Canada. There does not appear to be any evidence that the quality of care for diabetes is worse. Instead, the higher mortality rate has been linked to an overall increase in obesity and new cases of diabetes, primarily among men.⁶

Use the pull-down menu to compare the change in Canada’s mortality rate due to diabetes with that of its peers.

Diabetes is one of the most common conditions afflicting Canadians: an estimated 2 million Canadians suffer from diabetes, a figure that is expected to rise to 3 million in the coming decade.⁷ Estimates for the prevalence diabetes range from 1 in every 30 Canadians to 1 in every 11 Canadians.⁸

Diabetes has implications for the health-care system and for individuals suffering from the disease. A person with diabetes can face medication and supply costs in the range of $1,000 to $15,000 a year. Diabetes-related costs—such as lab tests, physician services, and kidney dialysis—amount to $15.6 billion every year, a figure that is expected to reach $19.2 billion by 2020.⁹

Diabetes is a chronic, often debilitating, and sometimes fatal disease that occurs when there are problems with the production and use of insulin in the body, ultimately leading to high blood sugar levels. Long-term complications from diabetes include kidney disease, diminishing sight, loss of feeling in the limbs, and cardiovascular disease.

There are three types of diabetes:

• Type 1 is sometimes called “insulin dependent” and is considered to be an autoimmune reaction that attacks the insulin-producing cells of the pancreas.
• Type 2 diabetes is referred to as “non-insulin dependent” or “adult onset.” It is usually controlled through diet, regular exercise, oral medication, and sometimes insulin injections.
• Gestational diabetes develops during pregnancy and usually goes away after.

About 90 to 95 per cent of all diabetes cases are type 2.¹⁰ The number of people with type 2 diabetes is increasing dramatically because of Canada’s aging population, rising obesity rates, increasingly sedentary lifestyles, and higher risk for diabetes for Aboriginal people and new Canadians.¹¹

Physical activity, healthy eating, weight loss, not smoking, and stress reduction may help delay or prevent the onset of type 2 diabetes. One study showed that people at risk of type 2 diabetes were able to reduce their risk by 58 per cent by exercising moderately for 30 minutes a day and by losing 5–7 per cent of their body weight.¹²

The Canadian Community Health Survey has found links between being overweight and having concurrent high blood pressure, diabetes, and heart disease.¹³ Technological and treatment advances have improved Canada’s performance on heart disease, dropping the rate from 231.8 deaths per 100,000 population in 1980 to 97.2 in 2002. However, the rising incidence of diabetes in Canada also portends a rise in the number of deaths from heart disease as the population ages and becomes more obese and sedentary. According to the Canadian Diabetes Association, 80 per cent of people with diabetes will die as a result of heart disease or stroke, and diabetes is a contributing factor in the death of about 41,500 Canadians each year.¹⁴

Other factors also come into play. Aboriginal people, for example, are three to five times more likely to develop type 2 diabetes than the general population.¹⁵ More than 75 per cent of new Canadians come from populations that are at higher risk for type 2 diabetes—including Hispanic, Asian, South Asian, and African populations. This is particularly troubling because the bulk of Canada’s population growth now comes from immigration.

One of the most disturbing indicators is the growing incidence of type 2 diabetes among children from these high-risk populations. When combined with rising child obesity rates, the warning signs indicate this may be the first generation of children in more than a hundred years who can expect worse health outcomes than their parents.

Yes. The increase in type 2 is due to behavioural and lifestyle choices. Obesity is one of the most significant contributing factors. A high body mass index (BMI) is a major risk factor for type 2 diabetes.¹⁶

"The percentage of Canadians who are overweight or obese has risen dramatically in recent years, mirroring a worldwide phenomenon", says researcher Michael Tjepkema in a report for Statistics Canada."¹⁷ In 2007, 15 per cent of Canadian adults were obese, with a BMI of 30 or more. Another 31 per cent were overweight, with a BMI of 25–30. "The most striking increases were among people younger than 35 and those 75 or older."¹⁸

Over the past 25 years, the number of Canadian children and adolescents who are overweight or obese has risen considerably, especially among youth between the ages of 12 and 17, whose obesity rate, according to another report from Statistics Canada, has tripled.¹⁹ This is especially concerning because "excess weight in adolescence often persists into adulthood."²⁰ It also likely explains the rise in the incidence of children developing diabetes. The likelihood of children being overweight or obese also rises as they spend more “screen time” in front of televisions, video games, or computers.

Men and women who eat fruit and vegetables less than three times a day are more likely to be obese.²¹ Among U.S. non-smokers, obesity at age 40 has been associated with a loss of 7.1 years of life for women and 5.8 years for men.²² The combined prevalence of being overweight and obese was about 70 per cent higher in 2004 than it was in 1978–79, and the prevalence of obesity alone was 2.5 times higher.²³

Interprofessional health-care teams and case management can improve the quality of care for chronic diseases like diabetes and heart disease. Information technology can support these interprofessional health-care teams by giving health-care system managers and policy makers tools such as registries for chronic diseases. And yet, although 90 per cent of family physicians in nine European countries and Australia use computers for at least some element of caring for patients, according to a recent study, only 20 per cent of Canadian family physicians used computers.²⁴ The most common use is managing patient drug prescriptions, followed by receiving laboratory results online.

Type 2 diabetes is a complex disease with a high burden of complications, according to a 2003 study from the Diabetes In Canada Evaluation (DICE). Physicians have difficulty managing diabetes as part of their daily practice. The DICE study showed that one in two Canadians with type 2 diabetes do not have their blood sugar under control, and that the longer patients have diabetes, the less likely they are to control their blood sugar.

The use of effective drugs for diabetic care is low also in Canada. The DICE study cited “clinical inertia” as the reason why knowledge is not being translated into more aggressive treatment plans.²⁵ Canada’s rate of 1 general practitioner per 1,000 population no doubt adds to the burden felt by doctors treating patients with diabetes and related co-morbidities.

Only half of the family physicians in Canada say their practices are well prepared to handle patients with multiple chronic health conditions. In its report Why Health Care Renewal Matters: Lessons from Diabetes, the Health Council of Canada states that less than one-half of Canadians with diabetes get all the lab tests and procedures that experts recommend to monitor blood sugar levels, blood pressure, cholesterol, kidney health, vision, and foot health. Yet research suggests that when people with diabetes receive higher levels of preventive care, their health is better than when they do not.²⁶

The Council points out that seeing a family physician does not always indicate a higher level of care. It found that only half of general practitioners refer their patients for more active support such as nutrition or fitness counselling.

A landmark U.K. diabetes study showed that a combination of intensive blood sugar control and oral medications was more effective than the typical approach, where doctors first try dietary and weight control measures before going on to medication.²⁷ Consequently, the Canadian Diabetes Association’s 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada now call for a more aggressive treatment approach. The DICE study showed that although family physicians are knowledgeable about these guidelines, they still rely on lifestyle modifications rather than early blood sugar control and oral medication.

And although family physicians need help implementing these more aggressive treatment guidelines, patients also have to take responsibility for their own health.

Finally, in 2005, the federal government committed $300 million over five years to the Integrated Strategy on Healthy Living and Chronic Disease. Its target is a 20 per cent increase by 2015 in the number of Canadians who are physically active, follow healthy diets, and achieve a healthy body weight. With targets now set, governments and partner organizations need to devise mechanisms for tracking and reporting on progress towards the national targets.

¹ International Diabetes Federation, Diabetes Epidemic Out of Control, Press release, December 4, 2006, [online, cited August 18, 2008].

² International Diabetes Federation, Diabetes Facts, [online, cited Auguest 26, 2009].

³ International Diabetes Federation, Diabetes Atlas, Impaired Glucose Intolerance [online, cited August 26, 2009].

⁴ International Diabetes Federation, “Backgrounder,” Diabetes Atlas, Third Edition (2006), p. 2, [online, cited August 18, 2008].

⁵ Missing data up to 2006 were obtained by projecting the most recent year of data using a 10-year average annual growth rate.

⁶ Public Health Agency of Canada, “Mortality,” Diabetes in Canada, First Edition (Ottawa: Author, 1999), [online, cited August 18, 2008].

⁷ Canadian Diabetes Association, The Prevalence and Costs of Diabetes, April 2008, [online, cited August 18, 2008].

⁸ The 1 in 30 estimate comes from Margot Shields, “Overweight and Obesity Among Children and Youth,” Health Reports (Statistics Canada, Catalogue 82-003, 2006). The 1 in 11 estimate for Canada was calculated by André Picard, “Diabetes Putting Care System in Dire Straits,” Globe and Mail, March 2, 2007. Picard’s estimate was based on Ontario figures in “Trends in Diabetes Prevalence, Incidence, and Mortality in Ontario, Canada 1995–2005: A Population-Based Study” by Lorraine Lipscombe and Janet Hux.

⁹ Canadian Diabetes Association, The Prevalence and Costs of Diabetes, April 2008, [online, cited August 18, 2008].

¹⁰ International Diabetes Federation, Types of Diabetes, [online, cited August 26, 2009].

¹¹ Canadian Diabetes Association, The Prevalence and Costs of Diabetes, April 2008, [online, cited August 18, 2008].

¹² Canadian Diabetes Association, The Prevalence and Costs of Diabetes, April 2008, [online, cited August 18, 2008].

¹³ Michael Tjepkema, "Adult Obesity," Health Reports, 17, 3, Cat. No. 82-003 (Ottawa: Statistics Canada, August 2006), p. 19.

¹⁴ Canadian Diabetes Association, The Prevalence and Costs of Diabetes, April 2008, [online, cited August 18, 2008].

¹⁵ Canadian Diabetes Association, The Prevalence and Costs of Diabetes, April 2008, [online, cited August 18, 2008].

¹⁶ Michael Tjepkema, "Adult Obesity," Health Reports, 17, 3, Cat. No. 82-003 (Ottawa: Statistics Canada, August 2006), p. 19.

¹⁷ Michael Tjepkema, "Adult Obesity," Health Reports, 17, 3, Cat. No. 82-003 (Ottawa: Statistics Canada, August 2006), p. 9.

¹⁸ Michael Tjepkema, "Adult Obesity," Health Reports, 17, 3, Cat. No. 82-003 (Ottawa: Statistics Canada, August 2006), p. 12.

¹⁹ Margot Shields, “Overweight and Obesity Among Children and Youth,” Health Reports, 17, 3, Cat. No. 82–003 (Ottawa: Statistics Canada, August 2006), p. 38.

²⁰ Margot Shields, “Overweight and Obesity Among Children and Youth,” Health Reports, 17, 3, Cat. No. 82–003 (Ottawa: Statistics Canada, August 2006), p. 38.

²¹ Michael Tjepkema, "Adult Obesity," Health Reports, 17, 3, Cat. No. 82-003 (Ottawa: Statistics Canada, August 2006), p. 14.

²² Anna Peeters et al., “Obesity in Adulthood and Its Consequence for Life Expectancy,” Annals of Internal Medicine, 138, 1 (January 2003), pp. 24–32.

²³ Margot Shields, “Overweight and Obesity Among Children and Youth,” Health Reports, 17, 3, Cat. No. 82–003 (Ottawa: Statistics Canada, August 2006), p. 29.

²⁴ Canadian Medical Association, Multi-National Study Shows International Doctors Ahead of Canadians, Press release, July 12, 2006, [online, cited August 18, 2008].

²⁵ Canadian Diabetes Association, DICE Study Backgrounder (Toronto: Author, 2005), p. 2.

²⁶ Health Council of Canada, Why Health Care Renewal Matters: Lessons From Diabetes (Toronto: Author, March 2007), p. 13.

²⁷ Canadian Diabetes Association, DICE Study Backgrounder (Toronto: Author, 2005), p. 4.