Diabetes

Diabetes is a largely preventable, global epidemic that costs the Canadian health care system billions of dollars each year. More than 3 million Canadians live with diabetes, and another 6 million have prediabetes which can increase the risk of developing type 2 diabetes. This means that one in 4 Canadians either has diabetes or is an advanced risk.

The Canadian Diabetes Association (CDA) defines diabetes as a chronic, often debilitating, and sometimes fatal disease in which the body either cannot produce insulin, or cannot properly use the insulin it produces. Since the body needs insulin to use glucose as an energy source, this leads to high levels of blood glucose, which can damage organs, blood vessels and nerves.

Type 1 diabetes is an autoimmune disease that occurs when the pancreas no longer produces any insulin or very little insulin. Type 1 diabetes usually develops in childhood or adolescence, accounting for up to 10% of people with diabetes. This otherwise fatal disease can be treated with lifelong insulin injections, along with careful attention to diet and exercise. At a recent health symposium, Dr. Hugh Tildesley, a leading Vancouver endocrinologist, heralded the insulin pump as greatly improving the ability of type 1 diabetics to live a normal life. However, he noted that coverage of the device varies among provinces and private health plans.

Type 2 diabetes occurs when the pancreas does not produce enough insulin to meet the body’s needs and/or the body becomes resistant to insulin. Type 2 diabetes usually occurs later in life, and accounts for about 90% of people with diabetes. It is treated with careful attention to diet and physical activity and usually medications (oral antihyperglycemic pills) and/or insulin.

Prediabetes develops when a person’s blood glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. Nearly 50% of prediabetics will develop type 2 diabetes.

THE FINANCIAL BURDEN OF DIABETES AND ITS COMPLICATIONS IS ENORMOUS.

People with diabetes incur medical costs that are two to three times higher than those without diabetes. Direct costs for medication and supplies range from $1,000 to $15,000 a year.
By 2020, it’s estimated that diabetes will cost the Canadian healthcare system $16.9 billion a year.

The driving forces behind the increase in incidence of diabetes in Canada include aging, rising obesity rates, sedentary lifestyles, and the ethnic mix of new immigrants who have a greater predisposition to diabetes. These factors are expected to remain and even intensify in the coming years.

WHAT CAN BE DONE?

There is no known way to prevent type 1 diabetes, but the onset of type 2 may be prevented or delayed through increased physical activity, weight loss, and healthy eating. The CDA notes one large study found that risk could be reduced by 58% through 30 minutes of moderate daily exercise and by losing just 5 to 7 % of body weight. In people 60 years of age and older, the risk was cut by about 71%.

In the workplace, promoting and allowing time for exercise and providing healthy food options will have a positive effect on preventing diabetes and allow those with diabetes to better manage their disease. Employers may need to make some accommodations for employees with diabetes: a private area to test blood sugar levels or take insulin, breaks for food or drinks, or a place to rest until blood sugar levels return to normal. Employees may also need to leave for treatment or training on managing diabetes.

Unfortunately, fewer than half of Canadians with type 2 diabetes are at the recommended target blood glucose levels, and more than half do not know their recommended target levels. Fewer than half of those with type 2 diabetes are regularly tested for A1C (average blood glucose) level, blood pressure and cholesterol levels or kidney function. Genevieve Sadak, Director of Occupational Services, LifeMark Health, points to the fact that "As part of a very effective strategy in the workplace, fasting or non-fasting testing of blood glucose can provide the early detection of undiagnosed, or pre-diabetes. Many are at risk due to lifestyle and diet management. Limited access to a primary care provider can be a barrier to early detection or effective management for a diabetic employee." In addition to screening programmes, employers might also consider providing or subsidizing the cost of one-on-one health coaching for their employees.

Sources: (1) Canadian Diabetes Association, www.diabetes.ca. See: An economic tsunami: the cost of diabetes in Canada. (2) The US Equal Employment Opportunity Commission’s report on Diabetes in the Workplace and the American with Disabilities Act, last updated Feb 2011. Available at www.eeoc.gov/facts/diabetes. (3) Ekoe J, M Aras M, P Markon, et al., 2008. Insight into Canadians Living with Type 2 Diabetes: A Survey of patients And Physicians. Presentation from the 2008 Canadian Cardiovascular Society annual meeting; Montreal, Quebec. (4) Diabetes Task Force, 2004. Report to the [Ontario] Ministry of Health and Long-Term Care.
(5) See also businesshealth (Spring 2007) for more information on workplace screening and programmes.