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.

Data source: IDF Diabetes Atlas 10th Edition (2021)

In 2018, Diabetes Canada estimated the number of Canadians living with diabetes to be in excess of 5 million with at least that many more living with pre-diabetes. Those numbers continue to grow.

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.

* The burden of diabetes affects not only youth and their families but also school and healthcare systems, employers and workplace productivity, demands on healthcare providers, medical education curricula and national economies; with a growing cost impacting all Canadians.

* Effective responses are impeded by shortfalls in Canadian healthcare systems and processes;

> incomplete Canadian surveillance data for youth-onset diabetes by age, gender, diabetes type, date of diagnosis, ethnicity and location.

> Gaps in the implementation of essential in-school support processes for students with diabetes.

> Continuity of care for youth living with diabetes remains challenging. Systemic disconnects between the paediatric and adult healthcare system increase the potential for dangerous lapses in continuity of care. Presence of mental health difficulties and other comorbidities necessitate multi-disciplined care teams and can further amplify healthcare systemic disconnects.

Newly Diagnosed Diabetes Impact on Families

A family with a youth living with diabetes can face new costs ranging from $1,000 to $15,000 per year or higher depending on diabetes type and severity.

Being diagnosed with diabetes can be a shock for the individual as well as the family. It is not uncommon for youth to feel depressed and discouraged by such a diagnosis. Type 1 diabetes presents one with a very steep learning curve; for example, how and when to administer insulin and how much to inject each time.

Both types require immediate changes in diet and general life style and families face a new set of needs when it comes to grocery shopping and meal preparation.

Normal routines are disrupted by the need to schedule regular visits to supporting medical professionals. Taking a trip or playing team sports, for example, require new pre-planning considerations.

The collective demands can be overwhelming and not surprisingly, the period of adjustment can be protracted and discouraging.

Difficulty in adjusting can trigger anxiety and various eating disorders.

Depression is noted by some to be the most common mental disorder occurring in youth living with diabetes. A related, but different, condition called Diabetes Stress or ‘burnout’ can arise as a result of the endless demand for management of diabetes.

To help keep their youth safe at school, parents need to prepare an Individual Care Plan, file it with the school and keep it up-to-date.

It is imperative for families to recognize that eventually, their youth will need to move from the paediatric to adult health care system. That ‘transition’ can be daunting if left to the last minute. Get started early to acquire an understanding of what is required and how you can ensure continuity of support. In many jurisdictions, that transition needs to be completed by age 19 or sooner.

 

Both Type 1 and Type 2 diabetes are life-long conditions.
Learning to thrive, not just survive, with diabetes requires your commitment. You need support from family, healthcare providers, teachers, friends and peers.

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 9% of global health expenditure is spent on diabetes and related complications. The 10th World IDF Diabetes Atlas (Nov 2021) estimated annual diabetes healthcare expenditure worldwide to treat diabetes and prevent complications (adults 20 – 79) had grown to USD 966 billion.

In Canada, the comparable number is estimated to be USD 30 billion.

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

Approximately 6.7 million adults (20-79) died from diabetes in 2021; one death every 5 seconds.

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 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 (Amed et al, Nov 22, 2017) 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.”