Introduction

Diabetes is recognized as a public health problem of potentially enormous proportions. In Canada, at least 5,500 deaths per year can be directly attributed to this disease, which ranks as the seventh leading cause of death. Diabetes often leads to life-threatening and debilitating conditions such as blindness, kidney disease, nerve damage, amputation, heart attack and stroke. When deaths due to all of these complications of diabetes are included, diabetes is said to account for approximately 25,000 deaths per year in Canada.

Yet Type 2 diabetes, the most common form of the disease and the focus of this report, is largely preventable. Primary prevention consists of increasing physical activity, establishing healthy eating habits and achieving and maintaining healthy body weight. Research has shown that these changes are effective in reducing the incidence not only of Type 2 diabetes, but also of cardiovascular disease, hypertension and other non-communicable diseases. Primary prevention requires a long-term, sustained effort but is clearly a good investment in our future.

In November 1999, the Government of Canada launched the Canadian Diabetes Strategy. Diabetes prevention is one of four components of this comprehensive national initiative. This environmental scan is the first initiative of the Prevention and Promotion component of the strategy in the Atlantic region. It was commissioned by the Atlantic Regional Office of the Population and Public Health Branch of Health Canada to provide a foundation for planning strategies for the primary prevention of Type 2 diabetes. The environmental scan was intended to examine Atlantic Canada data relating to diabetes and to obtain information about major initiatives that contribute to the primary prevention of this disease. It was also intended to describe primary prevention of diabetes within a population health framework

This document is not intended as a comprehensive review of diabetes but rather as a tool for stimulating reflection, discussion and debate about strategies for action in the region. Section one describes a population health approach to diabetes. Section two, Current Status, provides a statistical picture of diabetes within the Atlantic region, while section three, Current Prevention Activity, describes the wide range of provincial or regional initiatives that contribute to the prevention of diabetes. Concerted Action, the final section, integrates the information included in the first three sections and identifies that the actions needed to launch a serious concerted strategy for preventing diabetes.

A Diabetes Primer DIABETES is a condition in which the body either cannot produce insulin or else cannot effectively use the insulin it produces. INSULIN is a hormone produced by the beta cells of the pancreas that helps to regulate the amount of glucose in the blood. If the pancreas is unable to produce insulin, a person develops Type 1 diabetes and must administer insulin through injections. If the pancreas does not produce enough insulin, or the body cannot use the insulin that is produced, a person develops Type 2 diabetes and may require oral medication or insulin injections. TYPE 1 DIABETES (previously known as insulin-dependent diabetes mellitus) occurs when the pancreas is unable to produce insulin. It is caused by the destruction of the beta cells in the pancreas by the body's immune system. It usually develops in childhood or adolescence but may appear at any age. At this time there is no known means of preventing Type 1 diabetes, therefore this document does not pertain to this type of diabetes. TYPE 2 DIABETES (previously known as non-insulin-dependent diabetes mellitus) occurs when the pancreas does not produce enough insulin to meet the body's needs or the insulin is not used effectively. It is a highly preventable condition usually diagnosed after the age of 35. It accounts for 90% of all diabetes and is the form of diabetes discussed in this report. Type 2 diabetes is usually treated through healthy eating and physical activity, although some people must also take oral medication or insulin injections. PRIMARY PREVENTION of diabetes includes activities that are aimed at preventing diabetes from occurring in susceptible people or populations through modifications to the environment and changing behavioural risk factors. This covers any changes undertaken prior to development of clinical diabetes. There are two broad approaches to primary prevention of diabetes. One is the population approach, which targets risk factors in a whole population or group. The second is targeted towards reducing the risk factors for individuals. SECONDARY PREVENTION of diabetes covers methods such as screening to detect diabetes as early as possible in order to reverse or halt side effects. TERTIARY PREVENTION of diabetes includes any measure undertaken to prevent complications and disability due to diabetes among people who already have the disease.

 

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