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Canada Still Has A Chance To Reverse Its Diabetes Epidemic

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Earlier this year I retired after a dozen years as president of Innovative Medicines Canada. Shortly after I took an assignment with the Canadian Diabetes Association and the opportunity to work on what is one of Canada's largest and most perplexing challenges: our diabetes epidemic.

For years public health authorities have been sounding the alarm. But the tone has become more urgent in recent years -- with terms like "burning platform" and "crisis" increasingly used.

Since 2000, the prevalence of diabetes has more than doubled. In the next 10 years, both prevalence and direct health-care costs for diabetes are projected to grow by more than 40 per cent.

In 2016, an estimated 29 per cent of Canada's population have either diabetes or prediabetes. The prevalence of diabetes in Canada is now slightly higher than in the United States. In fact, Canada has the second highest prevalence rates in recent study of 34 Organization for Economic Cooperation and Development (OECD) countries.

In medical and human terms, the numbers are staggering.

This is having a profound impact on the health of millions of Canadians, and costs our health-care system billions of dollars per year. In medical and human terms, the numbers are staggering:

Diabetes reduces the average lifespan by five to 15 years. It is estimated that one of 10 deaths in Canadian adults was attributable to diabetes in 2008-2009.

  • People with diabetes are over three times more likely to be hospitalized with cardiovascular disease, 12 times more likely to be hospitalized with end-stage renal disease and over 20 times more likely to be hospitalized for a non-traumatic lower limb amputation compared to the general population.
  • Diabetes contributes to 30 per cent of strokes, 40 per cent of heart attacks, 50 per cent of kidney failure requiring dialysis and 70 per cent of non-traumatic lower limb amputations.
  • Thirty per cent of people with diabetes have clinically relevant depressive symptoms; individuals with depression have an approximately 60 per cent increased risk of developing type 2 diabetes.
  • The risk of blindness in people with diabetes is up to 25 times higher than those without diabetes. Diabetes is the leading cause of acquired blindness in Canadians under the age of 50. Diabetic retinopathy affects 500,000 Canadians.

Fifty-seven per cent of Canadians with diabetes say they do not comply with their prescribed therapy because they cannot afford their medications, devices and supplies, thus potentially compromising their diabetes management. These costs are particularly difficult for low-income Canadians, such as those who do not receive social assistance, seniors on fixed incomes, or those who have high drug costs but do not qualify for other forms of assistance.

Diabetes is the epidemic of our time along with the obesity epidemic. Obesity and type 2 diabetes can go hand-in-hand, so it's often called "diabesity." Canada has among the highest percentages of the adult population living with obesity. Sixty-two per cent of adults and 31 per cent of children are overweight or obese.

Some populations are at higher risk of type 2 diabetes, such as those of South Asian, Asian, African, Hispanic or Aboriginal descent, those who are overweight, older or have low income. Diabetes rates are three to five times higher in First Nations than in the general population, a situation compounded by barriers to care for indigenous peoples.

Diabetes policy programs in Canada

Perhaps the biggest tragedy about diabetes is that an estimated 90 per cent of diabetes cases and 60 per cent of complications are preventable by modifying risk factors and better managing diabetes. Diabetes shares several modifiable risk factors with other chronic diseases; these risk factors include obesity, poor diet and physical inactivity. Canada performs poorly on risk factors such as obesity and diet, particularly relative to countries with a low prevalence of diabetes, such as Sweden and the Netherlands.

It is clear that we need to do more.

For children, the World Health Organization recommends at least 60 minutes per day of moderate to vigorous physical activity. In Canada, only 14 per cent of girls and 25 per cent of boys meet this target.

Created in 1999 with initial funding of $115 million over five years, the Canadian Diabetes Strategy (CDS) focuses on the prevention and management of type 2 diabetes and its complications.

In 2005, the CDS became part of the Integrated Strategy on Healthy Living and Chronic Disease, with increased funding of $18 million per year. The strategy focuses on promoting health; preventing chronic disease by reducing risks for Canadians who are at high risk; and supporting early detection and management of chronic diseases.

The Aboriginal Diabetes Initiative (ADI) focuses on increasing awareness of diabetes among First Nations, Inuit and Métis in order to reduce the prevalence and incidence of diabetes in these high-risk communities. Supporting over 600 programs for indigenous people living with diabetes in Canada, the ADI was renewed with permanent funding in 2015.

Changes to the Canada Food Guide and planned restrictions to children's advertising will help. But it is clear that we need to do more -- we need a massive coordinated effort by all governments, health professionals, schools and parents if we are to reverse this terrible epidemic.

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