Diabetes in Alberta

• Among Albertans (1):
  • 26% live with diabetes or prediabetes and 
  • 8% live with diagnosed diabetes, a figure that climbs to 12% when cases of undiagnosed type 2 diabetes are included.
• 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 Canadians 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).
• Diabetes contributes to (5): 30% of strokes leading cause of blindness, 40% of heart attacks, 50% of kidney failure requiring dialysis, 70% of all non-traumatic leg and foot amputations.
• The prevalence of clinically relevant depressive symptoms among people living with diabetes is approximately 30% (6). Individuals with depression have a 40% – 60% increased risk of developing type 2 diabetes (6).
• Diabetic retinopathy is the leading cause of vision loss in people of working age (7). Vision loss is associated with increased falls, hip fractures, and a 4-fold increase in mortality (7). The prevalence of diabetic retinopathy is approximately 25% in Canada (8). 
• Foot ulceration affects an estimated 15%–25% of people with diabetes in their lifetime (9). One-third of amputations in 2011–2012 were performed on people reporting a diabetic foot wound (10). 
• 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 people 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 18.5% among people of African descent, 15.5% among people of South Asian descent, and 6.3% among people of East/Southeast Asian descent.
  • Diabetes rates are 3.5 times higher in First Nations People off reserve and 1.4 times higher in Métis than in the non-Indigenous population, a situation compounded by barriers to care for Indigenous peoples (12,13).  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 3.9 times that of adults in the highest income group (13).
  • Adults who have not completed high school have a diabetes prevalence 7 times that of adults with a university education (13).
• For many Canadians with diabetes, adherence to treatment is affected by cost. The majority of Canadians with diabetes pay more than 3% of their income or over $1,500 per year for prescribed medications, devices, and supplies out-of-pocket (2,14). 
• Among Canadians with type 2 diabetes, 33% do not feel comfortable disclosing their disease to others (2).
• Hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) may affect mood and behaviour and can lead to emergency situations if left untreated (11).

• 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, sex, and ethnicity (11).
  • The median age in Alberta is 36.7 years (15). 12.3% of Albertans are over 65 years old (15). 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 (16).
  • 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 (15). These groups are at increased risk of developing type 2 diabetes (11). 
  • There are 258,640 Indigenous Peoples in Alberta, who face significantly higher rates of diabetes and adverse health consequences than the overall population (17). 
• Alberta has high rates of individual-level modifiable risk factors (18):
  • 41.8% of adults and 56.9% of youth are physically inactive;
  • 36.3% of adults are living with overweight, 29.7% of adults are living with obesity, and 25.6% of youth are living with overweight or obesity;
  • 74.5% of adults are not eating enough fruits and vegetables; and
  • 14.1% 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).
  • Alberta had the largest increase in diabetes prevalence during the last 10 years among the provinces and is projected to also experience the largest increase over the next 10 years (1).
  • Albertans with diabetes living in non-metro health zones have lower rates of specialist care visits and higher use of hospital and emergency departments for acute and chronic complications of diabetes.

1. Implement Diabetes 360°

• Implement a provincial diabetes strategy that aligns with the Diabetes 360° framework.
• Support the F/P/T process to establish a nationwide diabetes framework.

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. Diabetes statistics in Canada are estimates generated by the Canadian Diabetes Cost Model, a forecasting model that provides projections on prevalence, incidence and economic burden of diabetes in Canada based on national data from government sources.
2. 2015 Report on Diabetes – Driving Change. Ottawa: Diabetes Canada; 2015. Estimated out-of-pocket costs for type 1 and type 2 diabetes were calculated based on composite case studies. As such, the estimates may reflect the out-of-pocket costs for many people with diabetes in Canada, but not all. The costs are 2015 estimates and may vary depending on income and age. 
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. Twenty Years of Diabetes surveillance using the Canadian Chronic Disease Surveillance System [Internet]. Ottawa: Public Health Agency of Canada; 2019 Nov. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/twenty-years-of-diabetes/64-03-19-2467-Diabetes-Infographic-EN-11.pdf
5. Hux J, Booth J, Slaughter P, Laupacis A. Diabetes in Ontario: An ICES Practice Atlas. Institute for Clinical Evaluative Sciences; 2003 Jun. 
6. Diabetes Canada Clinical Practice Guidelines Expert Committee, Robinson DJ, Coons M, Haensel H, Vallis M, Yale J-F. Diabetes and Mental Health. Can J Diabetes. 2018 Apr;42 Suppl 1:S130–41. 
7. Diabetes Canada Clinical Practice Guidelines Expert Committee, Altomare F, Kherani A, Lovshin J. Retinopathy. Can J Diabetes. 2018 Apr;42 Suppl 1:S210–6. 
8. Thomas RL, Halim S, Gurudas S, Sivaprasad S, Owens DR. IDF Diabetes Atlas: A review of studies utilising retinal photography on the global prevalence of diabetes related retinopathy between 2015 and 2018. Diabetes Res Clin Pract. 2019 Oct 23;107840. 
9. Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients With Diabetes. JAMA. 2005 Jan 12;293(2):217–28. 
10. Denny K, Lawand C, Perry SD. Compromised Wounds in Canada. Healthc Q [Internet]. 2014 May 16 [cited 2021 Oct 12];17(1). Available from: https://www.longwoods.com/content/23787/healthcare-quarterly/compromised-wounds-in-canada
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 [Internet]. 2018 [cited 2019 Oct 28];42. Available from: http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf
12. Diabetes Canada Clinical Practice Guidelines Expert Committee, Crowshoe L, Dannenbaum D, Green M, Henderson R, Hayward MN, et al. Type 2 Diabetes and Indigenous Peoples. Can J Diabetes. 2018 Apr;42 Suppl 1:S296–306. 
13. Public Health Agency of Canada, Pan - Canadian Public Health Network, Statistics Canada, Canadian Institute of Health Information. Pan-Canadian Health Inequalities Data Tool, 2017 Edition [Internet]. Public Health Agency of Canada. 2019 [cited 2019 Oct 31]. Available from: https://health-infobase.canada.ca/health-inequalities/data-tool/
14. The burden of out-of-pocket costs for Canadians with diabetes. Ottawa: Diabetes Canada; 2011. Out-of-pocket costs that exceed 3% or $1,500 of a person’s annual income are defined as catastrophic drug costs by the Kirby and Romanow Commissions on healthcare.
15. Alberta [Province] and Canada [Country] (table). Census Profile. 2016 Census [Internet]. Ottawa: Statistics Canada; 2019 Nov. Report No.: Statistics Canada Catalogue no. 98-316-X2016001. Available from: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/index.cfm?Lang=E
16. Diabetes Canada Clinical Practice Guidelines Expert Committee, Meneilly GS, Knip A, Miller DB, Sherifali D, Tessier D, et al. Diabetes in Older People. Can J Diabetes. 2018 Apr;42 Suppl 1:S283–95. 
17. Aboriginal Peoples Highlight Tables, 2016 Census [Internet]. Statistics Canada; 2017 Oct [cited 2019 Dec 17]. Available from: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/abo-aut/Table.cfm?Lang=Eng&S=99&O=A&RPP=25
18. Statistics Canada. Health characteristics, annual estimates [Internet]. 2020 [cited 2021 Oct 20]. Available from: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009601