Report Highlights

Chapter 1 Diabetes

Diabetes is a chronic condition that results from the body's inability to sufficiently produce and/or properly use insulin. Insulin, a hormone secreted from beta cells in the pancreas, assists with the conversion of glucose into energy. Without insulin, the cells of the body, primarily in muscle, fat, and liver tissue, cannot absorb sufficient glucose from the bloodstream. Chronic high levels of blood glucose can result in long-term damage, leading to the dysfunction and failure of various organs, such as the kidneys, eyes, nerves, heart, and blood vessels. Complications in these organs can lead to death.

Diabetes occurs in several forms: type 1, type 2, and gestational diabetes. Type 1 and type 2 are the two most common forms of this chronic disease and represent about 10% and 90% of the total diabetic population respectively.

Chapter 2 Prevalence and Incidence

Diabetes continues to be a significant health problem in Canada. The administrative data from the NDSS, based on information from all provinces and territories with the exception of New Brunswick, Newfoundland and Labrador, Northwest Territories and Nunavut, identified a prevalence of physician-diagnosed diabetes of 4.8% among people aged 20+ years (approximately 1,054,100 in 1998/99). The true prevalence may be significantly higher however, as it has been estimated that as many as one third of all cases of diabetes are undiagnosed in Canada. Therefore, altogether, there may have been as many as 1.7 million Canadians with diabetes during 1998/99.

Chapter 3 Risk Factors

The Canadian Diabetes Strategy has adopted a population health approach to prevent diabetes and improve its control. This strategy will reduce the risk of diabetes developing in individuals without the disease and reduce the risk of complications among those living with it. This chapter presents data, derived from the National Population Health Survey (NPHS), on the prevalence of risk factors for diabetes.

Risk factors for type 2 diabetes remain very common in the general population. In fact, the proportion of men who are overweight is increasing. Unless this trend is reversed, it will have serious ramifications for the prevalence of diabetes in the future. Although it is encouraging that both men and women are becoming more physically active, efforts to encourage regular physical activity must continue. In individuals with diabetes, risk factors such as high blood pressure, smoking, being overweight, and physical inactivity, which are associated with poor blood sugar control and diabetes-related complications, remain very common. Because the complications of diabetes reduce both the life span and the quality of life, this requires action as a high priority.

Chapter 4 Health Outcomes

Diabetes exerts a significant effect on the quality of life of those with the disease. The continuous need to monitor intake (in terms of timing, type, and amount of food), take medication (whether pills or insulin injections), monitor blood glucose, and anticipate and plan for activities that may affect diabetes control can put a severe strain on daily life. This is a particular challenge for children and youth with diabetes, who face the task of fitting in with their peers while coping with the demands of treatment. In addition, the complications of diabetes can cause other serious health problems that may lead to disability or be life-threatening.

Individuals with diabetes are less likely than those without diabetes to report good health. In addition, they more often report that they experience activity restriction. The negative impact of diabetes may be due to diabetes-related complications and/or the challenges associated with diabetes care.

The higher rate of mortality due to diabetes among men than women is consistent with the slightly higher prevalence of diabetes among men. In addition, men tend to develop cardiovascular disease complications, which carry a high mortality rate, more often than women.

The levelling off of mortality rates may mislead health planners into thinking that the diabetes problem has stabilized. In fact, it is projected that the number of deaths will increase in the future in both men and women because the population is aging. These individuals will need a variety of health services in the acute, chronic, and home care sectors for many years before death. Thus, coping with this increasing need for service requires immediate preparation, not only to address the current situation but also to be effective for the next 20 years.

Chapter 5 Use of Health Services and Costs

Individuals with diabetes require a variety of health services, not only for the control of their disease but also for the diagnosis and treatment of associated complications. Therapy for individuals with diabetes aims to control blood sugar, blood pressure, and blood lipids levels; to reduce symptoms and the risk of complications; and to enhance the quality of life. Blood sugar levels can be controlled through diet and anti-hyperglycemic drugs taken orally and/or by injections of insulin combined with lifestyle modification (healthy eating, active living, smoking avoidance/cessation, and stress management). Pharmacologic interventions combined with these lifestyle modifications also form a necessary part of managing the complications of diabetes.

The data on medication use support the nature of type 2 diabetes: that it can be controlled early in the course of the disease in some circumstances without the use of insulin. The increase in total units of hypoglycemic agents dispensed over time may be due to their high use among seniors, a segment of the population that is growing over time. This increase may also reflect the aggressive management of the disease with the use of medication to more closely control blood sugar, since type 2 diabetes is a progressive disease.

The higher hospitalization rate among men than women may be a consequence of the higher rate of cardiovascular complications among men. The lack of a decrease in hospitalization rates for diabetes in any age group contradicts the hospitalization rate in general, which has shown a steady decrease in the past several years. This may signal that the level of serious health problems among individuals with diabetes has not decreased. It also attests to continued pressure on hospital budgets.

In Canada, the economic burden of diabetes alone is estimated at $1.6 billion in 1998; $0.4 billion (25%) in direct costs and $1.2 billion (75%) in indirect costs. This estimate is a very conservative one and does not include physician costs. In addition, the hospital costs include only the leading cause of hospitalization, and this results in an underestimation of the real burden of diabetes, because the cost of the complications of diabetes are not captured.

Chapter 6 Diabetes in the Aboriginal Communities

The high prevalence of diabetes among Aboriginal peoples (higher than in the general population), the greater severity at diagnosis and the high rates of complications are a few indicators of the importance of this issue to all Aboriginal communities.

In addition, several risk factors have an enormous impact on diabetes in Aboriginal groups and have worsened the disease for a population already at risk.

The overall prevalence of diabetes among Aboriginals and the complications of the disease are expected to increase in future years and will represent a huge burden for health authorities. A study conducted in Manitoba showed the magnitude of this problem. It is estimated that between 1996 and 2016 there will be a 10-fold increase in the rate of cardiovascular disease, a 5-fold increase in strokes, 10 times as many dialysis starts, 10 times the rate of lower extremity amputations, and 5 times the rate of blindness.

Despite the lack of information on the precise costs of diabetes among Aboriginals, it is estimated that the costs are high as a result of both the high prevalence of diabetes and the substantial utilization of health care services by people with diabetes.

Because of the serious consequences of diabetes for individuals and their communities, the prevention of diabetes is therefore imperative and is the key to reducing this epidemic. Public health policies and especially community-based diabetes projects must be developed and implemented in order to reduce the burden of diabetes among Aboriginal peoples.

A Final Word

A full understanding of the implications of diabetes on the lives of Canadians requires more data to differentiate between the types of diabetes. More data will be needed in the following areas:

• incidence and prevalence;
• risk factors in children and youth;
• complications of diabetes;
• utilization of outpatient services;
• attendance at educational programs;
• economic impact of diabetes; and
• quality of life and impact on family, school and work.

The difficulties in obtaining accurate data on the prevalence and incidence of diabetes highlight the need for an ongoing comprehensive surveillance system. The NDSS addresses the critical information gaps regarding diabetes in Canada. The goal of the NDSS is to develop a national standardized database for diabetes surveillance with long-term monitoring for diabetes-related complications and health services utilization. However, other sources, such as the NPHS and the Canadian Community Health Survey (CCHS) will continue to provide important socio-economic data, and it is imperative that they be continued.

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