Diabetes in British Columbia

• Among British Columbians (1):
  • 31% live with diabetes or prediabetes and
  • 11% live with diagnosed diabetes, a figure that climbs to 16% 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).
• 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 11.1% among people of South Asian descent, 7.1% among people of East/Southeast Asian descent, and 14.5% among people of Arab/West Asian descent.
  • Diabetes rates are 4.5 times higher in First Nations People off reserve and 2.2 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 3.5 times that of adults in the highest income group (13).
  • Adults who have not completed high school have a diabetes prevalence 5.9 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 June 2021, the government announced coverage of the Dexcom G6 continuous glucose monitoring device available for those requiring insulin therapy aged 2+ who meet eligibility criteria.
• Effective April 2021, the government introduced a tax of seven percent on soda beverages to help address obesity and type 2 diabetes.
• On January 1, 2020, Medical Service Plan (MSP) premiums were eliminated for all British Columbians.
• In May 2019, the government launched its Biosimilars Initiative which introduced changes for children and adults using insulin. To maintain public coverage, Individuals using an originator insulin will be required to switch to its biosimilar.
• In November 2019, the government announced its commitment to using the Diabetes 360˚ framework to develop a provincial diabetes strategy.
• On January 1, 2019, the government eliminated PharmaCare deductibles for households earning up to $30,000 in annual net income and reduced deductibles for households earning up to $45,000.
• In July 2018, the government eliminated age restrictions from its insulin pump program. At the same time, the program was tiered, providing one pump model at no charge and others available through PharmaCare if special authority approval is received.
• In 2014, the government introduced provincial standards to support students with diabetes in schools, which includes staff training to administer glucagon in an emergency, as well as monitor blood sugar and administer insulin for students who are unable to manage their diabetes independently.

British Columbia 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 British Columbia is 43 years (15). 18.3% of British Columbians are over 65 years old (15). The risk of developing type 2 diabetes increases with age (15). 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 31.6% of British Columbians 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 270,585 Indigenous Peoples in British Columbia, who face significantly higher rates of diabetes and adverse health consequences than the overall population (17).
• British Columbia has high rates of individual-level modifiable risk factors (18):
  • 35.5% of adults and 43.6% of youth are physically inactive;
  • 36.2% of adults are living with overweight, 23.6% of adults are living with obesity, and 21.1% of youth are living with overweight or obesity;
  • 75.6% of adults are not eating enough fruits and vegetables; and
  • 10.1% 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 British Columbians include income, education, food security, the built environment, social support, and access to health care (3).

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.