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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Commonly referred to as Juvenile Diabetes, because it’s often diagnosed in childhood. However, it can also be diagnosed in adults. Type 1 diabetics have a pancreas that produces little or no insulin, which requires insulin management through medication that is usually injected.
Type 2 diabetes is a chronic condition that almost always develops in adulthood — which is why it’s sometimes referred to as adult-onset diabetes. "About 90 per cent of diabetics are Type 2, meaning that their ability to produce adequate levels of insulin is highly compromised and they have significant levels of insulin resistance,” says Dr. Barry Sears, president of the Inflammation Research Foundation. "The combination leads to significant increases in a variety of additional disorders — in particular heart disease and Alzheimer’s — in addition to the standard problems of loss of vision, increased amputation, and kidney failure."
Insulin is a hormone. It’s produced by the islet cells of the pancreas, and its role is to regulate glucose levels in the blood. The pancreas secretes insulin into the bloodstream, where it works to allow sugar to enter the cells and lowers the level of sugar in your bloodstream. As blood sugar drops, the secretion of insulin from the pancreas does too. While both types of diabetes involve insulin and the functioning of the pancreas, there are key differences in their causes and treatments.
Symptoms of type 1 diabetes include the emergence of bedwetting in children, frequent thirst, frequent urination, unintended weight loss, extreme hunger, blurred vision, and fatigue.
With type 2 diabetes, the condition can exist for years before diagnosis. But many of the symptoms are the same as with type 1: blurred vision, unexplained weight loss, excess thirst and urination, fatigue. Also watch for sores or infections that are slow to heal, as type 2 diabetes can affect your ability to heal and fight infection. As well, areas of darkened skin (acanthosis nigrican) in creased areas like the armpits and neck are a sign of insulin resistance.
A variety of factors may contribute to the development of type 1 diabetes, according to the Mayo Clinic, including possible genetics and exposure to certain viruses. Risk factors for the disease include family history and young age, with peaks in outset occurring between ages 4 and 7 and ages 10 and 14.
With type 2 diabetes, the risk factors include having excess fatty tissue, carrying fat around the abdomen, having a family history of diabetes, being inactive, having polycystic ovary syndrome, and getting older. As well, people of black, Asian, Hispanic, and Aboriginal backgrounds are at higher risk of developing type 2 diabetes, though it’s not known why.
Interestingly, the incidence of type 1 diabetes increases as you travel away from the equator, according to the Mayo Clinic, leading some researchers to think it could develop more readily in winter than summer. The highest incidences of type 1 diabetes are found in Finland and Sardinia, for example, where rates are about double or triple those in the U.S. and 400 times those in Venezuela.
It’s unknown exactly what causes type 1 diabetes, but in those with the condition, the immune system attacks the insulin-producing cells of the pancreas. In type 2 diabetes, the islet cells are still functioning as they should, to release insulin — the problem instead is that the pancreas doesn’t produce enough insulin, the body becomes resistant to the insulin, or both. But while we know about some contributing factors, it’s also not known exactly what causes type 2 diabetes.
Type 1 and type 2 diabetes can both have serious effects on your health if not managed. Diabetes can affect your eyes, heart, blood vessels, nerves, and kidneys, though keeping your blood sugar levels well managed does a lot to mitigate these effects. Nerve damage can manifest in loss of feeling or pain, usually beginning in the feet or hands. It could cause gastrointestinal problems or erectile dysfunction. Damage to the blood vessels in the kidneys can lead to kidney failure or kidney disease. Eye problems are also seen in some diabetics, and problems in pregnancy are also a risk.
Prevention of type 2 diabetes can be done in part through dietary choices, and making sure you get enough magnesium may be one of them. "Magnesium plays a pivotal role in the secretion and function of insulin,” Dean says. “Without it, Type 2 diabetes is inevitable.” Measurable magnesium deficiencies is common with the condition, she says, and related to many of the related complications.
Managing stress and anxiety can also help to keep your overall health steady, including possibly staving off type 2 diabetes. "The connection between stress, obesity and diabetes cannot be overlooked,” Dean says. "The stress chemical cortisol signals a metabolic shutdown that makes losing weight almost impossible. Magnesium can neutralize the effects of stress and is known as the anti-stress mineral.” And of course, if you do have diabetes, it’s easier to manage your condition if you aren’t overwhelmed.
There is no cure for type 1 diabetes, though the disease is manageable and treatment has advanced considerably in recent decades. Those with type 1 diabetes must take insulin for the duration of their lives; the physician works with the patient to find the best insulin and dose for blood sugar maintenance. Other medications may be required for related conditions. Not all type 2 diabetics require insulin therapy, but some do. For both types, regular exercise and a healthy diet, along with weight control, can also help keep glucose levels consistent.
For some type 2 diabetics, bariatric surgery may be an option to lose weight and control the disease. However, the surgery does involve serious risks that should be discussed with your physician.
If you suspect you or a family member has type 1 or type 2 diabetes, it’s important to seek medical help as soon as possible. It may be helpful to keep track of your symptoms leading up to the appointment, and go in with a list of your medications and general information about your diet and exercise routines.
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