Diabetes Prevalence – How many are living with diabetes?

Diabetes strikes indiscriminately and prevalence differences exist for regions of the world, ethnicity, environment, age, gender, life-style and diabetes ‘type’. For example, it is estimated that more men have diabetes than do women globally and, in general, the prevalence of diabetes is higher in urban areas than in rural.

As at the end of 2016, there were approximately 3.5 million Canadian adults living with diabetes and at least another 8 million living with pre-diabetes. The number of diagnosed cases in Canada is estimated to rise by 41% by 2026.

Diabetes is a worldwide pandemic with over 425 million adults (age 20 – 79) living with diabetes at the end of 2017. That is an increase of over 43 million cases in just 4 years. Another 352 million adults are living with pre-diabetes or impaired glucose tolerance.  Many people with pre-diabetes will develop diabetes within 10 years. Approximately 90% of diabetes cases in adults are Type 2.

It is estimated that almost half of the adults living with diabetes do not know they have the condition

The international Diabetes Federation estimates that 1.1 million youth age 19 and under are living with Type 1 diabetes worldwide as at the end of 2017. Given the evolving state of diabetes surveillance systems that collect such data, this is probably an underestimate. The estimate for youth living with Type 1 in Canada is 30,000 and growing.

No one knows how many children and youth are living with Type 2 diabetes but it is widely agreed the numbers are escalating in most countries. The rise in Type 2 diabetes in youth is strongly correlated with being over-weight or obese and an inactive life-style.

“Type 2 diabetes in childhood has the potential to become a global public health issue leading to serious health outcomes. More information ….  is needed urgently”
IDF World Diabetes Atlas, 8th edition, Nov 2017 (p 60)

The general diabetes pandemic impacts not just the patients and their families but also school systems, healthcare systems, employers, countries and medical education curricula.

Diabetes Economic Burden

Diabetes is a major and growing economic burden for all nations, jurisdictions and health systems. The complications that arise as a result of poorly managed diabetes add to that economic burden and the combination is one of the major causes of death in most countries.

Diabetes results in increased use of health services and contributes to reduced workforce productivity and increased disability.

IDF estimate, using complex modeling, that 12% of global health expenditure is spent on diabetes and related complications.

From 2006 to 2017, the estimated annual diabetes healthcare expenditure worldwide to treat diabetes and prevent complications (adults 20 – 79) has grown from USD 232 billion to USD 727 billion.

The cost of diabetes to the Canadian economy is estimated at $14 billion annually and is expected to reach at least $17 billion by 2020.

Diabetes Mortality

Diabetes and its complications are major causes of early death in most countries.

Approximately 4 million adults (20-79) died from diabetes in 2017; one death every 8 seconds. Deaths from diabetes were higher than the combined number of deaths for:

  • HIV/AIDS 1.1 million
  • Tuberculosis 1.8 million
  • Malaria 0.4 million

It is estimated that the indirect cost of premature death and disability arising from diabetes worldwide in 2017 was USD 69 billion.

Diabetes Demands on Support Systems

The increasing prevalence of diabetes in all ages presents an ever-growing demand for professional caregivers of many types, for example, pediatricians, family physicians endocrinologists, registered nurses, dieticians, diabetes educators, psychologists and psychiatrists .

The relatively new and evolving Type 2 diabetes epidemic in children and youth adds to the cost and resource demands and brings new, immediate requirements to undertake more research to close knowledge gaps across the full spectrum of diagnosis, treatment, identification of ‘best practices’ for self-management education (an essential survival skill), and to improve processes for surveillance, transition and continuity of care.

The varying combinations or ‘comorbidities’ of diabetes, obesity and mental health difficulties simply add to the challenges.

These demands bring new considerations for health policymakers, add complexity to resource allocation decisions and require adjustments in medical education curricula.

The range of required training, expertise and practical experience necessary to provide effective healthcare delivery in response is very wide and dictates much more effort required by governments to nurture and fund team-based approaches to health care delivery in support of youth living with diabetes and comorbid conditions.

Diabetes demands on Healthcare Professionals

Apart from the every day implications of the ‘knowledge gaps’ identified above, these considerations bring added complexity to many aspects of healthcare delivery and impact both paediatric and primary care practitioners, for example:

  • Recognition and interpretation of symptoms
  • Delivery of disease self-management education for youth and their families
  • Preparation and implementation of effective treatment and transition plans to assist youth and their families to move successfully from the paediatric to adult healthcare system. If comorbid conditions such as mental health issues exist, the challenge is greater, especially, for self-management education. Those who care for youth living with diabetes are not the same as those who care for youth with mental illness. Multi-disciplinary teams are needed for proper transition; not an easily met requirement for rural communities.
  • Processes for cross-discipline communication
  • Family physicians ‘inherit’ youth living with diabetes after their paediatric years and many are not ‘ready’ for that outcome. Limited consultation time and ineffective communication between involved healthcare professionals add to the challenge. A paper reporting research outcomes in British Columbia, Canada noted:

“The greatest burden of youth-onset type 2 diabetes is in older youth aged 15 to 19 years who likely access primary, rather than paediatric care. Therefore, increasing awareness of youth onset type 2 diabetes among primary care practitioners is critical to ensure early identification and initiation of management so as to prevent serious diabetes-related complications and early mortality.”
(Amed et al, Nov 22, 2017)