Diabetes in Newfoundland and Labrador

• Among Newfoundlanders and Labradorians (1):
  • 35% live with diabetes or prediabetes, and
  • 13% live with diagnosed diabetes, a figure that climbs to 19% 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 25.1% 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 rate of diabetes is 1.30 times higher in First Nations off reserve 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 7.3 times that of adults in the highest income group (13).
  • Adults who have not completed high school have a diabetes prevalence 6.1 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 Budget 2021, the government introduced a sugar-sweetened beverage tax to address the impact of chronic disease, such as diabetes as of September 2022.
• In January 2021, the insulin pump program was expanded to include full coverage for eligible individuals with type 1 diabetes up to age 18 years, and full coverage for those 18 to 25 years for individuals already in the program. New clients to the program 18 years and older will be income tested to determine public coverage.
• The Newfoundland Project: Diabetes Canada, in partnership with eDOCSNL, the provincial electronic medical records (EMR) program, and Boehringer Ingelheim, launched a pilot project integrating Diabetes Canada’s Clinical Practice Guidelines with the EMRs being used by health-care providers in a diabetes collaborative in Corner Brook. Phase Two began in 2021. 
• In May 2018, foot care for provincial Prescription Drug Program clients living with diabetes who also receive home support services was expanded to those who are over 65 years old.
• In June 2017, the government released its Chronic Disease Action Plan that included initiatives for diabetes.
• In 2014, the government released Guidelines for Diabetes Management in Schools.

Newfoundland and Labrador 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 Newfoundland and Labrador is 46 years (15). 19.4% of Newfoundlanders and Labradorians 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 2.8% of Newfoundlanders 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 45,725 Indigenous Peoples in Newfoundland and Labrador, who face significantly higher rates of diabetes and adverse healthconsequences than the overall population (17).
• Newfoundland and Labrador has high rates of individual-level modifiable risk factors (18):
  • 49.6% of adults and 53.1% of youth are physically inactive;
  • 35.3% of adults are living with overweight, 41.9% of adults are living with obesity, and 25.3% of youth are living with overweight or obesity;
  • 82.5% of adults are not eating enough fruits and vegetables; and
  • 19% 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 Newfoundlanders include income, education, food security, the built environment, social support, and access to health care (3).
  • Newfoundland and Labrador has a rural population higher than the national average (19). For people with diabetes, accessing care is more challenging in rural areas across Canada than in urban areas.
  • The median after-tax family income in Newfoundland and Labrador is among the lowest among the provinces (20).

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.