Diabetes in Alberta

• Among Albertans (1):
  • 26% live with diabetes or prediabetes and 
  • 9% live with diagnosed diabetes, a figure that climbs to 12% when cases of undiagnosed type 2 diabetes are included.
• Diabetes contributes to (5):

• Diabetes complications are associated with premature death (3). Diabetes can reduce lifespan by five to 15 years (3). It is estimated that the all-cause mortality rate among people living with diabetes is twice as high as the all-cause mortality rate for those without diabetes (4).
• People with diabetes are over three times more likely to be hospitalized with cardiovascular disease, 12 times more likely to be hospitalized with end-stage renal disease, and almost 20 times more likely to be hospitalized for a non-traumatic lower limb amputation compared to the general population (3).
• 33-50% of people living with diabetes experience diabetes distress (an overwhelming feeling about their condition that can lead to unhealthy habits like not checking their blood sugar or skipping medical appointments, etc.) (6).
• Individuals with depression have a 40% – 60% increased risk of developing type 2 diabetes (6).
• Diabetic retinopathy, a retinal vascular disorder that occurs as a complication of diabetes, is a leading cause of new cases of blindness in Canada, and often affects working-aged adults (7).
• Vision loss is associated with significant morbidity, including increased falls, hip fractures, and an increased risk of death (8).
• Foot ulceration affects an estimated 15-25% of people with diabetes in their lifetime (9).
• Compared to the general population, adults living with diabetes in Canada are over 20 times more likely to undergo non-traumatic lower limb amputations - 85% of which are preceded by foot ulcers (10).
• Hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) may affect mood and behaviour and can lead to emergency situations if left untreated (11).
• For people living with diabetes, adherence to treatment is affected by costs which are not covered by their public drugs and devices coverage (2).
  • Those with type 1 diabetes can pay up to 9% of their gross annual income on medications and devices that range from $78 to $6,557.
• Those living with type 2 diabetes can pay up to 8% of their gross annual income on medications and devices that range from $76 to $5,641.

Risk Factors for Diabetes

• The risk factors for type 1 diabetes are not well understood, but interaction between genetic and environmental factors are likely involved (11). Type 2 diabetes is caused by a combination of individual, social, environmental, and genetic factors (11).
• Certain populations are at higher risk of developing type 2 diabetes, such as those of African, Arab, Asian, Hispanic, Indigenous, or South Asian descent, those who are older, have a lower level of income or education, are physically inactive, or are living with overweight or obesity (11).
• The age-standardized prevalence rates for diabetes are 16% among people of South Asian descent, 13.3% among Black adults, 12.5% among people of Arab/West Asian descent, 8.8% among people of East/Southeast Asian descent, and 5.7% among people of Latin American descent (12).
• The prevalence of diabetes among First Nations adults living off reserve, Metis adults, and Inuit adults is 1.72 times,1.22 times, and 1.18 times higher respectively than the prevalence among non-Indigenous adult (12).  In addition to the risk factors that impact all people in Canada, the ongoing burden of colonization continues to influence Indigenous peoples’ health.
• The prevalence of diabetes among adults in the lowest income groups is 2.1 times that of adults in the highest income group (12).
• Adults who have not completed high school have a diabetes prevalence 1.9 times that of adults with a university education (12).
• Social determinants of health can influence the rate of individual-level modifiable risk factors and thus the risk of diabetes. The main determinants of health include income, employment, education, childhood experiences, physical environments, social supports, access to health services, and racism (13).

• In 2023 the work of the Alberta Diabetes Working Group (DWG) is underway with its subcommittees reviewing the gaps in access to medications, devices, services, and care for people at risk and living with diabetes in Alberta. The DWG will submit evidence-based recommendations to the Minister of Health in 2024.
•  July 2022, the Minister of Health announced the formation of a Diabetes Working Group with broad representation from Alberta’s diabetes community to deliver recommendations to the government on key priorities to build a comprehensive provincial diabetes strategy.
• In July 2022, the government cancelled its plan to make changes to the Insulin Pump Therapy Program (IPTP) that would require individuals to incur out-of-pocket costs.
• In February 2022, the government announced the addition of real-time continuous glucose monitors (rtCGM) for eligible Albertans under age 18.
• In July 2021, the government announced increased coverage up to $2,400 for diabetes supplies in government sponsored programs, including Blue Cross Coverage for Seniors and Non-Group Coverage.
• In December 2019, the government launched its Biosimilars Initiative which introduced changes for adults using insulin. To maintain public coverage, Individuals using an originator insulin will be required to switch to its biosimilar.  
• In February 2019, the Guidelines for Supporting Students with Type 1 Diabetes was released to offer guidance to provincial school boards.
• In 2016, the Diabetes, Obesity and Nutrition Strategic Clinical Network (DON SCN) released an Inpatient Diabetes Management Initiative in its effort to standardize how patients with diabetes are cared for in Alberta’s hospitals.
• In 2014, DON SCN released a provincial Diabetes Foot Care Clinical Pathway for Albertans with diabetes in its effort to reduce diabetic foot ulcers and amputations.

Alberta faces unique challenges in preventing type 2 diabetes and meeting the needs of those living with diabetes:

• Non-modifiable risk factors of type 2 diabetes include age, gender, and ethnicity (11).
  • The median age in Alberta is 36.7 years (14). 12.3% of Albertans are over 65 years old (14). The risk of developing type 2 diabetes increases with age (11). Older adults living with diabetes are more likely to be frail and progressive frailty has been associated with reduced function and increased mortality (15).
  • Adult men are more at risk of type 2 diabetes compared to adult women (11).
  • Approximately 24.8% of Albertans self-identify as being of African, Arab, Asian, Hispanic, or South Asian descent (14). These groups are at increased risk of developing type 2 diabetes (11).
  • There are 258,640 Indigenous people in Alberta, who face significantly higher rates of diabetes and adverse health consequences than the overall population (16).

• Alberta has high rates of individual-level modifiable risk factors (17).
  • 40% of adults and 74% of youth (aged 12 to 17 years) are physically inactive;
  • 36% of adults are living with overweight and 26.7% of adults are living with obesity;
  • 71.9% of adults are not eating enough fruits and vegetables; and
  • 18.4% of adults are current tobacco smokers.
• Factors related to the social determinants of health and that can influence the rate of individual-level modifiable risk factors among Albertans include income, education, food security, the built environment, social support, and access to health care (3).

1. Fund a provincial diabetes framework

• Allocate funding to develop and implement a comprehensive diabetes framework with measurable goals for improving diabetes prevention, treatment, and health outcomes for the province.

2. Expand access: Put patients at the centre of policy decisions

• Eliminate barriers, including age discrimination, to access evidence-based, personalized diabetes treatments, including diabetes medications, devices, and supplies.
• Provide equitable access to continuous glucose monitoring systems (isCGM & rtCGM) according to Diabetes Canada’s reimbursement recommendations.  

​3. Protect students with diabetes

• Implement a mandatory standard of care for students with diabetes that aligns with Diabetes Canada’s Guidelines for the Care of Students Living with Diabetes at School.

4. Prevent amputations

• Implement health policies that support the prevention and management of diabetes foot complications and reduce the risk of lower limb amputations.

1. Canadian Diabetes Cost Model. Ottawa: Diabetes Canada; 2016.
2. Diabetes and Diabetes-Related Out-of-Pocket Costs: 2022 Update. Diabetes Canada; 2022.
3. Diabetes in Canada: Facts and figures from a public health perspective [Internet]. Ottawa: Public Health Agency of Canada; 2011 p. 126. Available from: https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/pdf/facts-figures-faits-chiffres-eng.pdf
4. Public Health Agency of Canada. Twenty years of diabetes surveillance using the Canadian chronic disease surveillance system. [Internet]. 2019. Available from: http://publications.gc.ca/collections/collection_2019/aspc-phac/HP35-122-2019-eng.pdf
5. Hux J, Booth J, Slaughter P, Laupacis A. Diabetes in Ontario: An ICES Practice Atlas [Internet]. Institute for Clinical Evaluative Sciences; 2003. Available from: https://www.ices.on.ca/Publications/Atlases-and-Reports/2003/Diabetes-in-Ontario
6. Diabetes Canada Clinical Practice Guidelines Expert Committee, Robinson DJ, Coons M, Haensel H, Vallis M, Yale JF. Diabetes and Mental Health. Can J Diabetes. 2018 Apr;42 Suppl 1:S130–41.
7. Flaxel, Christina J.; Adelman, Ron A.; Bailey, Steven T.; Fawzi, Amani; Lim, Jennifer I.; Vemulakonda, G. Atma; Ying, Gui-shuang. Ophthalmology (Rochester, Minn.), 2020, Vol.127 (1), p.P66-P145
8. Vu, H. T., Keeffe, J. E., McCarty, C. A., & Taylor, H. R. (2005). Impact of unilateral and bilateral vision loss on quality of life. The British journal of ophthalmology, 89(3), 360–363. https://doi.org/10.1136/bjo.2004.047498 
9. Yazdanpanah, L., Shahbazian, H., Nazari, I., Arti, H. R., Ahmadi, F., Mohammadianinejad, S. E., Cheraghian, B., & Hesam, S. (2018). Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)-Two-Year Follow-Up Study. International journal of endocrinology, 2018, 7631659. https://doi.org/10.1155/2018/7631659 
10. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 Jun 15;376(24):2367–75
11. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2018;42(Suppl 1):S1:S325.
12. Public Health Agency of Canada. Pan-Canadian Health Inequalities Data Tool, 2022 Edition [Internet]. Available from: https://health-infobase.canada.ca/health-inequalities/data-tool/
13. Prinjha S, Wicklow B, Nakhla M, Banerjee AT. Toward the Goal of Understanding and Tackling the Social Determinants of Diabetes. Can J Diabetes. 2022 Aug 1;46(6):549–50.
14. Government of Canada SC. Census Profile, 2016 Census - Alberta [Province] and Canada [Country] [Internet].
15. Meneilly GS, Knip A, Miller DB, Sherifali D, Tessier D, Zahedi A. Diabetes in Older People. Can J Diabetes. 2018 Apr;42:S283–95.
16. Aboriginal peoples in Canada: Key results from the 2016 Census [Internet]. Ottawa: Statistics Canada; 2017 Oct p. 11. Available from: https://www150.statcan.gc.ca/n1/en/daily-quotidien/171025/dq171025a-eng.pdf?st=krvs_yCt
17. Canadian Risk Factor Atlas (CRFA), 2020 edition. Public Health Agency of Canada. Available at Public Health Infobase: https://health-infobase.canada.ca/crfa/