Ontario is facing a diabetes crisis
that has already exceeded World Health Organization
(WHO) projections for the year 2030.
The most recent WHO report predicted
that diabetes prevalence rates would rise 65% within
Canada and 60% globally between 1995 and 2030. However
a study in the March 3 issue of The Lancet shows
that between 1995 and 2005 alone, Ontario experienced
a 69% increase in diabetes prevalence rates (adjusted
for sex and age) among adults over 20. The proportion
of this population with the disease grew from 5.2% in
1995 to a worrisome 8.8% in 2005.
If this continues, by 2030 over
a fifth of the people in Canada's most populous province
could be affected.
"Unfortunately, this might become
a reality," says Dr Lorraine Lipscombe, an endocrinologist
at the Institute for Clinical Evaluative Sciences, in
Toronto, and the Lancet study's lead author.
"In the 10 years that we looked at it, the increase
in diabetes prevalence was linear, averaging 6.2% per
year and with no sign of slowing down. It would seem
the WHO figures seriously underestimated the severity
of this problem."
YOUNG
& DIABETIC
Dr Lipscombe's study looked at diabetes prevalence and
mortality among all adults over 20-years-old who were
eligible for OHIP coverage between 1995 and 2005, as
well as incidence rates from 1997 to 2003. Data were
obtained from anonymized, administrative healthcare
databases; any records with an obstetric event within
five months were kept out to exclude potential gestational
diabetes cases. The study didn't distinguish between
types I and II diabetes, though more than 90% of cases
were estimated to be type II.
Despite the fact that the study
focused only on Ontario — home to significant numbers
of susceptible ethnic groups, like South Asians —
Dr Lipscombe argues that her findings are more widely
relevant. "I think the province's population is representative
of the developed world," she says. Apart from the differences
in predicted and actual overall increases, Dr Lipscombe
notes that the study uncovered other, more troubling
findings. "Probably the most surprising was that, even
though people over 50 were much more likely to have
diabetes, the rate of increase was much more dramatic
among adults between 20 and 49," she says.
The prevalence of diabetes in the
older age group was 17% in 2005, an increase of just
over 60% from a decade earlier. While diabetes prevalence
among younger adults was still relatively minor in 2005,
at 3.5%, it constituted a 94% increase from what it
had been just 10 years earlier. "This was concerning
to us because it means younger people will live longer
with the disease and will have longer to develop complications,"
she says.
So what's causing this alarming
increase? "We couldn't look directly at obesity in our
study, but it's possible that we're seeing its impact
on the younger generation," Dr Lipscombe muses. "It
may be what's behind this almost doubling of diabetes
prevalence in young adults."
TEAM
APPROACH
Dr Lipscombe hopes that interventions aimed at reducing
the obesity burden among children today will reduce
the risk, or at least the severity, of a diabetes crisis
in the future. She points to the recent Health Council
of Canada (HCC) report on managing chronic illnesses
— which used type II diabetes as its focus and
promoted a multidisciplinary treatment methodology —
as a good starting point.
She said that if implemented by
policymakers the HCC report's recommendations would
improve care for people already living with the disease.
It would also help address its growing burden on our
healthcare resources, with the cost of direct care constituting
anywhere between 2.5% and 15% of health budgets. Also,
given the numbers of people who are going to require
care, she believes having a team approach would remove
some of the patient load from physicians, who are in
short supply in Ontario and elsewhere.
Despite all the negative findings
of her study, Dr Lipscombe stresses it did contain some
good news for Canadian doctors. "Frontline physicians
in particular deal with the bulk of diabetes cases,
and we've seen a 25% reduction in deaths under their
watch between 1995 and 2005," she says approvingly.
However, she cautioned these same
doctors to take greater care in identifying people at
risk of developing the disease. "These patients need
to understand that the risk and consequences of having
diabetes are very real, so doctors should take every
opportunity to counsel them and determine what the best
prevention strategy might be."
For more on treating diabetes
in primary care, see "Diarrhea, drug plans and alternative
funding: an FP's circles of hell" on page 42.
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