The diabetes epidemic

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ONLINE COVER FINAL

More than nine million Canadians are living with diabetes or prediabetes. With more than 20 people being newly diagnosed every hour of every day, chances are the disease affects someone you know. That could be a relative, friend, neighbour, co-worker or someone who’s part of your personal or professional community. In Ontario alone, there has been a 68 per cent increase between 1995 and 2005. The majority of cases are of type 2 diabetes and that is where most of the growth is seen. The need to ensure optimal care and outcomes for people living with diabetes has always been great, but is now being brought into sharper focus by the magnitude of the situation.

A chronic disease, diabetes is often debilitating and sometimes fatal. The body either cannot produce the hormone insulin (type 1 diabetes), or it cannot properly use the insulin it produces (type 2 diabetes). This leads to high levels of glucose (sugar) in the blood, which can damage organs, blood vessels and nerves and result in a variety of complications. To use sugar as an energy source, the body needs insulin. People with prediabetes have higher-than-normal blood sugar levels that aren’t high enough to be diagnosed with type 2 diabetes. Without intervention, 50 per cent of those people will develop type 2 diabetes.

What accounts for the dramatic rise in the number of people with diabetes?

There are four reasons for the rise in the numbers.

LONGEVITY People are living longer with diabetes, and we are successfully treating them. That’s a good news story, and we want that trend to continue even though it is a major contributor to the growing prevalence of diabetes.

GENES Genetic factors can put a person at greater risk of developing type 2 diabetes. We also know that the risk varies for people of different ethnicities. These factors cannot be modified. On the Canadian Diabetes Association’s (CDA’s) website at www.diabetes.ca, we have a risk assessment that provides people with more information about factors that could put them at risk for diabetes.

LIFESTYLE We are becoming a more sedentary society, consuming more calories, and more calories of an unhealthy variety. This can lead to obesity, which is of concern not only to people with diabetes, but to everyone. In Canada, obesity is a public health crisis. And like smoking, it needs a multi-pronged public health response.

ENVIRONMENT We are seeing that more recently designed neighbourhoods are unwalkable. Research, such as the CDA-funded study by Dr. Gillian Booth and her team, found that neighbourhood walkability was a strong predictor of a person’s risk of developing diabetes, independent of his or her age and income, particularly among recent immigrants. Poverty accentuated these effects. Linked to that is the idea that some neighbourhoods represent “food deserts,” where people have tremendous difficulty obtaining foods that are nutritious, such as fresh fruits and vegetables, that provide healthful calories. This can be due to unaffordability or unavailability, or both. For instance, if you live on First Nations reserve in northern Manitoba, it’s very difficult to get enough calories without eating a lot of added sugar.

Cover inside onlineWhat can health care professionals do to help people living with diabetes?

CREATE A CONNECTION. As part of the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (www.guidelines.diabetes.ca), we emphasize the importance of a person with diabetes connecting with a health care team. A person’s diabetes care team can include a family doctor, nurse, pharmacist, dietitian, endocrinologist, certified diabetes educator, and more. It’s a proven approach that can improve treatment and a person’s quality of life. Whether an individual is treated by many health-care professionals or just a few, it’s important for each team member to have a clear role that the patient understands, and for the team to talk to each other and share information. CDA volunteer Christina Vaillancourt, a registered dietitian and patient care specialist at Lakeridge Health Durham Region Diabetes Network in Whitby, Ont., believes that everything health-care professionals do should start with the person living with diabetes. In other words, the system should fit the patient, not the other way around.

SUPPORT EDUCATION. People living with diabetes need informationabout how to manage the disease and live healthily. Health-care professionals can play an important role in educating people and helping them put the information to practical use in their everyday lives. Encouraging a healthier lifestyle is an important goal for everyone, especially those with prediabetes. As the Diabetes Prevention Program (DPP) study showed, modest weight loss achieved through dietary changes and physical activity can delay or even prevent the onset of type 2 diabetes.

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At the CDA, we suggest small, simple steps that are realistic and achievable. Creating targets and goals is another way for people to stay on track with their diabetes management. We have tools on our website to help people prepare for diabetes visits, create action plans and track their progress – these can be used in conjunction with their health-care team. Other valuable resources, which the CDA has worked with volunteers to develop, include local support, whether it’s a peer-based support group; one-on-one support, in person and online; and webinars.

STAY INFORMED. The 2013 Guidelines provide health-care professionals with the best and most current evidence-based clinical practice data. They were developed over a five-year period by a CDA volunteer committee of diabetes experts who assessed and reviewed the latest scientific evidence about diabetes prevention and management. Rated among the best in the world, the 2013 Guidelines support the CDA’s commitment to being a global leader in diabetes care, management and prevention. We have just released the Clinical Practice Guidelines app (CDA CPG) for health-care providers – an interactive, searchable and mobile-friendly resource with interactive tools. It’s available from the App Store and Google Play.

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What’s new with diabetes?

TYPE 2 Twenty-five years ago in medicine, we had a rule of thumb that said anyone under the age of 30 with diabetes must have type 1 diabetes. That is no longer the case. Today, children are being diagnosed with type 2 diabetes. For instance, Dr. Jill Hamilton of the Hospital for Sick Children in Toronto says she sees children who are developing type 2 diabetes at an increasingly younger age in her practice. With funds from the CDA, Dr. Hamilton and her team are studying the link between mothers who develop gestational diabetes (which occurs during pregnancy) and their babies who may be at greater risk for obesity and diabetes later in life.

The face of diabetes is also changing among gender lines. Traditionally, the prevalence of diabetes (those living with the disease) has been higher in men, but the greatest increase in rates is among young women aged 20 to 49 years old.

TYPE 1 Unlike type 2, which can be prevented, the cause of type 1 is unknown and there is currently no cure. However, there are two good news research stories on the horizon.

Islet Transplants Canada’s first successful islet cell (the pancreatic cells that produce insulin) transplant was conducted in 1991 by Dr. Garth Warnock. Building on his work, a University of Alberta research team – whose investigative work is funded by the CDA – announced a breakthrough technique for islet cell transplantation for patients with severe type 1 diabetes. This became known as the Edmonton Protocol. As of June 2012, more than 300 islet cell transplant procedures have been successfully performed across Canada.

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Today, there are a host of researchers working in the area of islet cell transplantation. One of them is CDA-funded researcher, Dr. Pere Santamaria, a University of Calgary professor and director of the Julia McFarlane Diabetes Research Centre (which supports research focused on finding a cure for diabetes), who has developed a vaccine that could increase the success of transplants.

Artificial Pancreas – Whether it’s wearable or implanted, an artificial pancreas is an automated system that mimics a functioning pancreas by delivering insulin in response to the body’s changing glucose levels. De Montfort University in Leicester, England, recently announced that the first human trials of an implanted artificial pancreas created by one of its professors could be just two years away.

On this side of the pond, CDA-funded research by Dr. Rémi Rabasa-Lhoret and his team has evaluated conventional insulin pump therapy versus an insulin pump that uses a continuous glucose monitor (CGM) to calculate insulin dosages without any input from the wearer. Dr. Rabasa-Lhoret is currently comparing a two-hormone – insulin and glucagon (a hormone that responds to correct low blood sugar levels) – system that would function as a wearable artificial pancreas. It wouldn’t require any input from the wearer and would normalize blood sugar levels.

What’s ahead for people living with diabetes?

This spring, the CDA released the Diabetes Charter for Canada, which outlines the rights and responsibilities of people living diabetes, their caregivers, health-care providers, governments and others who may provide care and support. This all-hands-on-deck approach underscores how important it is for everyone to work together to fight this disease. Our hope is that this document will foster positive change that will lead to equal access to diabetes care and support for all Canadians living with diabetes or at risk for the disease, no matter where they live.