Diabetes in British Columbia KEY STATISTICS 1 Diabetes and prediabetes prevalent cases (rate) Diabetes prevalent cases (rate) Undiagnosed diabetes prevalent cases Type 1 diabetes prevalent cases Estimated increase in diabetes prevalent cases from 2016 to 2026 Annual out-of-pocket cost for type 1 diabetes administering insulin by multiple daily injections (% of income) 2 Annual out-of-pocket cost for type 1 diabetes, administering insulin with an insulin pump (% of income)2 Annual out-of-pocket cost for type 2 diabetes (% of income)2
Last updated: June 2016
2016 1.4 million (28.2%)
2026 1.8 million (31.9%)
199,000 23,150–46,300 46% $764–$2,819 (4%) $830–$4,726 (4%–11%) $1,515–$1,940 (2%–8%)
Impact of diabetes: •
Diabetes complications are associated with premature death. Diabetes reduces lifespan by 5–15 years. It is estimated that one of ten deaths in Canadian adults was attributable to diabetes in 2008–2009. 3 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.3 Diabetes contributes to 30% of strokes, 40% of heart attacks, 50% of kidney failure requiring dialysis, and 70% of nontraumatic lower limb amputations 4 and is a leading cause of vision loss. Thirty per cent (30%) of people with diabetes have clinically relevant depressive symptoms; individuals with depression have an approximately 60% increased risk of developing type 2 diabetes. 5 The risk of blindness in people with diabetes is up to 25 times higher than those without diabetes. 6 Diabetes is the leading cause of acquired blindness in Canadians under the age of 50. 7 Diabetic retinopathy affects 500,000 Canadians. 8 Foot ulceration affects an estimated 15%–25% of people with diabetes in their lifetime. 9 One-third of amputations in 2011–2012 were performed on people reporting a diabetic foot wound. 10 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 3–5 times higher in First Nations than in the general population, a situation compounded by barriers to care for Aboriginal people.5
Between 25%–57% of Canadians with diabetes indicated their treatment adherence was affected by cost. The majority of Canadians with diabetes pay more than 3% of their income or over $1,500 per year for needed medications, devices and supplies out of their own pocket. 11,12 Thirty-three per cent (33%) of Canadians with type 2 diabetes do not feel comfortable disclosing their diabetes to others.12 Hypoglycemia (low blood sugar) and hyperglycemia (elevated blood sugar) may affect mood and behaviour and a student’s ability to learn and to participate in school activities as well as lead to emergency situations, if left untreated.
Recent developments in diabetes-related policy, programs and services in British Columbia: •
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In September 2014, the province introduced provincial standards to support students with diabetes in schools. These significant changes to respond to the health needs of students with diabetes include staff training to administer glucagon in an emergency as well as monitor blood sugar and administer insulin for students who are unable to independently self-manage. In February 2014, British Columbia expanded the provincial insulin pump program to insure people to age 25. The program was first introduced for children and youth (18 years and under) in 2008. The B.C. government has taken steps to reduce generic drug pricing, including implementing a tiered pricing framework in 2014 as part of the pan-Canadian Pharmaceutical Alliance initiatives. A Childhood Healthy Weights Intervention Initiative was introduced in 2013. The province’s public health plan Promote, Protect, Prevent: Our Health Begins Here. B.C.’s Guiding Framework for Public Health (2013) sets a target to reduce the rate of diabetes incidence from 2009/10 baseline of 6.3 to 6 per 1,000 by 2023. Healthy Families B.C. Strategy (2011) focuses on healthy eating, healthy communities, healthy lifestyle and healthy start for babies. B.C.’s Guidelines and Protocols Advisory Committee produced a diabetes care guideline (2010). The provincial government provides financial support for the Food Skills for Families program, which is delivered by the Canadian Diabetes Association. British Columbia’s Primary Health Care Charter identifies diabetes management as a priority medical condition and establishes outcome measures. The province has family practice incentive programs and billing codes for physicians providing care for chronic illnesses including diabetes.
What does the Diabetes Charter for Canada mean for British Columbia? In 2016, an estimated 28.2% of British Columbians have either diabetes or prediabetes. Many others face higher risk of developing type 2 diabetes: • B.C. is home to 33% of Chinese, 20% of South Asians, 17% of Southeast Asians and Aboriginal people in Canada. Chinese people make up over 10% of the provincial population. 13 • Overweight and obesity were reported in 48% of adults and 19% of youth. 14,15
Given the increasing burden of diabetes in British Columbia, the Diabetes Charter for Canada (the Charter) is particularly relevant, in that it has established agreed upon rights for people living with diabetes as well as their responsibilities for their own care. The Charter also describes the rights and responsibilities of health-care providers, as well as the responsibilities of governments, employers, child-centred environments and workplaces. The Diabetes Charter for Canada is an important tool for all members of the diabetes community to address the needs of people living with diabetes in British Columbia. References 1
Diabetes statistics in B.C. are estimates generated by the Canadian Diabetes Cost Model, a forecasting model that provides projections on prevalence, incidence and economic burden of diabetes in Canada based on national data from government sources. 2 Estimated out-of-pocket costs for type 1 and type 2 diabetes were calculated based on composite case studies. As such, the estimates may reflect the out-of-pocket costs for many people with diabetes in B.C., but not all. The costs are 2015 estimates and may vary depending on income and age. For details on the methodology and estimates, please see the appendix in the Canadian Diabetes Association’s 2015 Report on Diabetes: Driving Change, available at https://www.diabetes.ca/getmedia/5a7070f0-77ad-41ad-9e95-ec1bc56ebf85/2015-report-on-diabetes-driving-change-english.pdf.aspx. 3 Public Health Agency of Canada. (2011). Diabetes in Canada: Facts and figures from a public health perspective. Ottawa, Ont.: Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php 4 Institute for Clinical Evaluative Sciences. (June 2003). Diabetes in Ontario: An ICES Practice Atlas. Retrieved from http://www.ices.on.ca/Publications/Atlases-and-Reports/2003/Diabetes-in-Ontario.aspx 5 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. (2013). Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes, 37 (suppl 1). 6 Thomann KH, Marks ES, Adamczyk DT. (2001). Primary Eye care in Systemic Disease; New York: McGraw-Hill. (Cited in http://www.cdc.gov/diabetes/ndep/pdfs/ppod-guide-eye-care-professionals.pdf; also by Ovenseri-Ogbomo, et al. 2013) 7 CNIB. About diabetic retinopathy. http://www.cnib.ca/en/your-eyes/eye-conditions/eye-connect/DR/About/Pages/default.asp). 8 CNIB. Eye connect: diabetic retinopathy. http://www.cnib.ca/en/your-eyes/eye-conditions/eye-connect/DR/Pages/default.asp). 9 Singh, N, Armstrong, DG, Lipsky, BA. (2005) Preventing Foot Ulcers in Patients with Diabetes. JAMA. 2005;293(2):217-228. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=200119#REF-JCR40054-1 10 Canadian Institute for Health Information. (2013). Compromised wounds in Canada. Ottawa, Ont.: Canadian Institute for Health Information. Retrieved from https://secure.cihi.ca/free_products/AiB_Compromised_Wounds_EN.pdf 11 Out-of-pocket costs that exceed 3% or $1,500 of a person’s annual income is defined as catastrophic drug costs by the Kirby and Romanow Commissions on healthcare. Please see Canadian Diabetes Association. (2011). The burden of out-of-pocket costs for Canadians with diabetes. Available at http://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/burden-of-out-of-pocket-costs-for-canadians-withdiabetes.pdf 12 Canadian Diabetes Association (November 2015). 2015 Report on Diabetes: Driving Change. Toronto, Ont.: Canadian Diabetes Association. Available at https://www.diabetes.ca/getmedia/5a7070f0-77ad-41ad-9e95-ec1bc56ebf85/2015-report-on-diabetes-driving-change-english.pdf.aspx 13 Statistics Canada. 2011 National Household Survey, data tables. 14 Statistics Canada. (2014). Body mass index, overweight or obese, self-reported, adult, by sex, provinces and territories. Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health82b-eng.htm 15 Statistics Canada. (2014). Body mass index, overweight or obese, self-reported, youth, by sex, provinces and territories. Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health84b-eng.htm