Diabetes in Canada OPPORTUNITIES FOR IMPROVED DIABETES SURVEILLANCE, PREVENTION, AND CONTROL

OPPORTUNITIES FOR IMPROVED DIABETES SURVEILLANCE, PREVENTION, AND CONTROL

Diabetes Today - A Summary of the Evidence

Diabetes is a significant public health problem in Canada today. Over a million Canadians are estimated to have diabetes, although many are unaware of their condition. It is the seventh leading cause of death based on mortality data that underestimate the true problem. Diabetes is the most common cause of end-stage renal disease, of new onset blindness in the working age population, and of lower limb amputations, and a noted risk factor for cardiovascular disease⁽¹⁸⁾. The increased morbidity seen with diabetes is clearly shown in this report. People with diabetes have poorer general health perception and more days of disability than people without diabetes. They have a much higher need for health care services.

There appears to be a trend toward increased diabetes prevalence from the analysis of the two NPHS surveys done to date, although this change is not statistically significant. Other indicators of increased prevalence, however, are the increasing rates of mortality from diabetes and the increase in the amount of diabetes medication dispensed in Canada. The number of Canadians with diabetes can be expected to increase on the basis of demographic factors, as the most common age of onset for Type 2 diabetes appears to be between 51 and 60 years of age. The oldest baby boomers are entering this decade of life now. It is expected, however, that the prevalence of diabetes will increase for two additional reasons: the incidence of Type 2 diabetes will probably rise as the major risk factor for diabetes, obesity, is increasing at this time; the second reason is that improvement in diabetes care should increase the survival of people with the condition after diagnosis.

A clear conclusion from this report is that information about diabetes in Canada is quite limited. There are limited data in Canada on the incidence and prevalence rates for diabetes at the provincial and subprovincial levels. In fact, the proportion of complications due to diabetes, such as loss of vision, is not known at the national level. It is at the subprovincial level that this information about diabetes is urgently needed, because decisions concerning diabetes prevention and control programs are made locally as a result of regionalization in almost all jurisdictions. As the evidence has mounted during the 1990s that the complications of diabetes and possibly diabetes itself are preventable, it is discouraging to note that information to assess baseline status and monitor progress is not available for this disease.

Addressing the Problem

Since diabetes is not a unique problem to Canada, it is perhaps best to learn from international experience. The Declaration of the Americas on Diabetes (DOTA) was endorsed by the Pan American Health Organization (PAHO) in 1996. This declaration proposed four Minimum Essential National Targets to improve the prevention and control of diabetes:

1. Create a national focal point for diabetes program development.
2. Establish national surveillance.
3. Create a national strategic plan for prevention and control.
4. Set national and local targets.

The first national target has been achieved in the creation of the Diabetes Council of Canada (DCC). This coalition of diabetes-related non-governmental organizations and federal government agencies can act as the focal point for diabetes program development. The Adult Health Division of Health Promotion and Programs Branch of Health Canada provides logistic and financial support to the DCC.

The second national target, to establish national surveillance, is an initiative of the DCC. The National Diabetes Surveillance System (NDSS) is being developed by the Laboratory Centre for Disease Control of Health Canada along with provincial and territorial governments, non-governmental organizations, academic clinicians, and other federal agencies. This proposed system will use existing administrative databases and record linkage to provide information such as the following: incidence and prevalence of Type 1 and Type 2 diabetes, incidence and prevalence of diabetes complications, diabetes management practices by health professionals and patients, ambulatory health care utilization, provision of diabetes education, quality of diabetes care, economic costs of diabetes, and the effectiveness of diabetes prevention and control programs.

The third national target is to create a national diabetes strategy for the prevention and control of diabetes. This has been discussed by the DCC, and a background document reviewing the relevant issues has been funded by Health Canada and will be completed early in 1999. This discussion paper is only the first step in a multi-sectoral consultation process. This strategy will need to address primary, secondary, and tertiary prevention of diabetes. The Aboriginal Diabetes Strategy at present being developed by Medical Services Branch and Aboriginal groups will be an integral part of a national diabetes strategy.

The final goal through DOTA is to set national and local targets based on epidemiologic and resource estimates. It is becoming no longer acceptable to fund disease prevention and control programs without knowing the present status of the disease and the planned outcome of the intervention. Clearly, this final step requires a functional national surveillance system and a well-coordinated prevention and control strategy.

Conclusion

Diabetes is a significant problem in Canada today. Although limited surveillance makes the picture of this disease incomplete, it is clear that diabetes will exact an increasing burden on Canadians in the near future. The complications of diabetes can be prevented, however, and there is some evidence that Type 2 diabetes can be prevented through lifestyle modification. A logical approach to this problem is provided through PAHO's Declaration of the Americas on Diabetes. Action has begun along the path to improved diabetes surveillance, prevention, and control. These goals can be achieved through the vision and persistance of all diabetes stakeholders in Canada.

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