Finding diabetes before it finds us

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Diabetes is a serious but manageable disease. When patients have the right education and information, they can manage their disease and expect to live active, vital lives. While the number of diagnoses are going up every year, it’s the undetected disease that causes concern.

Since diabetes is more common in certain ethnic populations, it is no coincidence that the diabetes care centre at The Credit Valley Hospital is one of the largest in Canada. Credit Valley is a community hospital located in the sixth fastest growing city in Canada – Mississauga. It is also home to one of the most ethnically diverse populations in Canada.

With five endocrinologists on staff at Credit Valley, the centre offers care, education and prevention information for diagnosed patients and those at risk for developing type 2 diabetes.

Recently, the federal government announced a grant to support a new project to help citizens in the Mississauga area determine if they have type 2 diabetes or if they are at risk for developing the disease. Aside from risk factors such as being overweight and over 40 years of age with a family history of diabetes, the Canadian Diabetes Association indicates that members of high risk groups such as those of Hispanic, Asian, South Asian and African decent have an increased risk of developing type 2 diabetes. The fact is that almost 80 per cent of new Canadians come from populations at higher risk for Type 2 diabetes.

The CANRISK project tool examines the results of an oral glucose tolerance test combined with the score of a questionnaire for patients between 40 and 74 years of age. The questionnaire includes information about family history, body weight, lifestyle and other factors. The combined results of the two tests determines whether the patient has the disease or ‘pre-diabetes’ which puts them at risk for developing type 2 diabetes.

Recognizing the risk for Canadians and the significant impact diabetes and its complications has on our health-care system, the government identified an opportunity to detect the disease early – even in the pre-diabetes stage which offers Canadians the chance to better manage their health and at least delay onset of the disease.

“Catching the disease early means we can intervene early to prevent further complications of diabetes for our patients which can also alleviate the escalating crisis on the health-care system,” says Debbie Hollahan, manager, diabetes care center, The Credit Valley Hospital. The financial burden of diabetes and its complications is enormous. By 2010, diabetes will cost the Canadian health-care system, $15.6 billion a year and $19.2 billion by 2020.

“Diabetes detection, education and care is a priority for our population,” says Hollahan. Peel Public Health department recently received $1 million from the Ministry of Health Promotion to generate awareness and education while the Local Health Integration Network (LHIN) has also identified diabetes as a priority. Credit Valley is the seventh site in Canada to launch the initiative but the first ethnic, urban population since the other sites were in rural Canada.

“Partnerships are key to our success,” says Hollahan. The three diabetes education centres in our LHIN represent the biggest in the country and we also work closely with community partners to reach out to target audiences for education and awareness. Credit Valley has linkages with community centers such as South Common Mall to provide education through teaching as well as an exercise component.

One of the unique challenges realized and addressed has resulted in a swimming program exclusive to women of Muslim origin. “Swimming is a popular option for exercise but it posed a significant hurdle for this population of women due to their religious beliefs regarding personal modesty, so we worked with the community centre to arrange time exclusive to this group. Now, they are enjoying swimming as exercise; the community centre even offers babysitting for their children,” says Hollahan.

“We are very excited about the awareness that will be generated by the testing and for the patients who will learn about pre-diabetes so that we can teach them to better manage their disease,” says Hollahan. The CANRISK screening tool has been translated into Urdu and Punjabi and will be available in additional languages in the future.

Thus far, 2300 adults have been screened in projects across Canada. The testing has detected 5 per cent new undiagnosed diabetes cases and 15 per cent new pre-diabetes cases. The pilot projects have shown that over half of the at-risk for diabetes cases would not have been detected though normal screening methods.

Diabetes affects an estimated 246 million people worldwide including three million people in Canada. The number of cases is rapidly growing with an expected 380 million worldwide projected to have the disease by 2025.