Tackling the Diabetes Epidemic through a Population Impact Approach

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Jan Hux is the President and CEO of Diabetes Canada. Canadians have been at the forefront of tackling diabetes since the discovery of insulin. Now that the disease has become an epidemic, measures must be put in place to tackle it at a population level.

 

If diabetes prevalence were a swimming pool, we would have both more and more people remaining in it as well as more people jumping in. Our pool is nearly overflowing.

In 1921, when Dr Frederick Banting discovered insulin, diabetes was a relatively rare disease that mostly affected the very young (for whom a diagnosis of type 1 diabetes was a death sentence) or the elderly. Today, our reality is very different. 11 million Canadians live with diabetes or prediabetes. The number of Canadians living with this progressive, chronic disease has doubled over the last 12 years and in just a little more than the amount of time it will take you to read this article (approximately three minutes) another Canadian will have been diagnosed with diabetes.

 

The reasons for the exponential growth in how common diabetes is are numerous. Some good news: people are living much longer with diabetes than a century ago, and half of the growth in prevalence can be attributed to improved survival. Some not so good news: the environment in which we all live, and our lifestyles today promote the development of type 2 diabetes. The results are simple: we eat too much of the “wrong” foods and don’t move nearly enough.

 

If diabetes prevalence were a swimming pool, we would have both more and more people remaining in it as well as more people jumping in. Our pool is nearly overflowing.

 

Yet despite what the numbers state, a recent opinion poll showed that Canadians underestimate the severity of the disease. At least initially. People were often uaware of the life-threatening complications that may occur from diabetes: people with diabetes account for 70 percent of all non-traumatic lower limb amputations; 50 percent of kidney failure requiring dialysis; 40 percent of heart attacks; and 30 percent of strokes. Once respondents were presented with these facts, they ranked diabetes in the top three chronic diseases that the Government of Canada should make as a priority (by improving access to care, improving technology, developing new drugs, etc.)

 

Diabetes Canada was set up at a time when the rarity of the disease meant that the needs of the population could be met by one-on-one care and advice provided in a series of small storefronts scattered around Canada. Today, though, that approach is both a luxury we can’t afford and an insufficient response to what has become an epidemic.

 

To address the diabetes epidemic in Canada, it is imperative that we take a multi-faceted and population-wide approach to reducing risk and improving management.

That’s why Diabetes Canada has embraced a new strategic direction centred on delivering impact at a population level, rather than an individual level. We still provide advice, tools and connections for people with diabetes to help them live well with the disease. But increasingly we are devoting our resources to influencing policies and systems that shape our health environment.

 

I am really excited about our plan to do just that: Diabetes 360°.

 

Diabetes 360° is an innovative and strategic framework with clearly defined targets and outcomes. It was developed by a coalition of nearly 120 experts in healthcare, government, the private sector and education from across Canada and modelled on the proven, ambitious approach used for HIV/AIDS and other global disease prevention and management strategies. Diabetes 360° also sets considerations unique to Indigenous peoples in Canada, and engagement with Indigenous peoples and groups has been a cornerstone of the process of developing the strategy. Diabetes 360° is set up to deliver results in just seven years by focusing on the following key targets:

  • 90 percent of Canadians live in an environment that preserves wellness and prevents the development of diabetes
  • 90 percent of Canadians are aware of their diabetes status
  • 90 percent of Canadians living with diabetes are engaged in appropriate interventions to prevent diabetes and its complications
  • 90 percent of Canadians engaged in interventions are achieving improved health outcomes.

 

It will require a financial commitment from our federal government in the short-term but the long-term benefits will more than pay for the upfront investment by helping to prevent nearly a million diabetes cases from developing and save more than CAD nine billion in healthcare costs in the next seven years.

 

To address the diabetes epidemic in Canada, it is imperative that we take a multi-faceted and population-wide approach to reducing risk and improving management. Yet Canada’s current response to this critical issue can be characterized as a collage of inequities in disease prevention, access to health services, treatments, devices and supplies.

 

Diabetes Canada’s Guidelines to support healthcare providers informed our Diabetes 360° recommendations. Importantly, so too did input from patients. People living with diabetes are behind the development of our call for a national strategy providing valuable insights into many of our recommendations to governments.

 

The end of another calendar year brings us even closer to 2021 – the 100th anniversary of the discovery of insulin – Canada’s gift to the world. Diabetes Canada’s goal is to recognize this milestone with another significant achievement in diabetes – the adoption of a nationwide strategy to improve the prevention and management of diabetes. I’m optimistic that Canada is on the cusp of making great things happen for those living with or at risk of diabetes, and feel privileged to lead the organization at the forefront of that.

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