Diabetes in Saskatchewan

• Among the population of Saskatchewan (1):
  • 27% live with diabetes or prediabetes and
  • 9% live with diagnosed diabetes, a figure that climbs to 13% 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 5% of their gross annual income on medications and devices that range from $623 to $7,745.
  • Those living with type 2 diabetes can pay up to 8% of their gross annual income on medications and devices that range from $414 to $6,055.

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 October 2022, the government announced its Biosimilars Initiative requiring individuals to switch from a biologic drug to a biosimilar insulin.
• In June 2021, the government eliminated the age restriction from the provincial insulin pump program for eligible individuals with type 1 diabetes and introduced coverage of continuous glucose monitoring devices (isCGM & rtCGM) for eligible children and youth under age 18.
• In May 2020, the Ministry of Education released the Policy Statement: Supporting Students with Potentially Life-Threatening Medical Conditions (e.g., allergies, asthma, diabetes, epilepsy) in Saskatchewan Schools.
• The Saskatchewan Children’s and Seniors’ Drug Plans are available to children aged 14 and younger and eligible seniors aged 65 and older, who pay up to $25 per prescription for drugs on the Saskatchewan Formulary and those approved under Exception Drug Status.

Saskatchewan 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 Saskatchewan is 37.8 years (14). 15.5% of people in Saskatchewan 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 11.5% of people in Saskatchewan 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 175,015 Indigenous Peoples in Saskatchewan, who face significantly higher rates of diabetes and adverse health consequences than the overall population (16).
• Saskatchewan has high rates of individual-level modifiable risk factors (17):
  • 44.1% of adults and 77.7% of youth (aged 12-17 years) are physically inactive;
  • 37% of adults are living with overweight and 33% of adults are living with obesity;
  • 72.5% of adults are not eating enough fruits and vegetables; and
  • 21.3% 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 include income, education, food security, the built environment, social support, and access to health care (3).
  • Saskatchewan has a large rural population (18). For people with diabetes, accessing care is more challenging in rural areas across Canada than in urban areas.

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.