Diabetes in Canada

Prevalence (1)	2023	2033
Diabetes (type 1 + type 2 diagnosed + type 2 undiagnosed)	5,883,000 / 15%	7,417,000 / 17%
Diabetes (type 1 and type 2 diagnosed)	4,118,000/ 10%	5,192,000 / 12%
Diabetes (type 1)	5-10% of diabetes prevalence
Diabetes (type 1 + type 2 diagnosed + type 2 undiagnosed) and prediabetes combined	11,939,000 / 30%	14,156,000 / 33%
Increase in diabetes (type 1 and type 2 diagnosed), 2023-2033	26%
Increase in diabetes (type 1 and type 2 diagnosed + prediabetes), 2023-2033	17%
Out-of-pocket cost per year (2)
Type 1 diabetes costs, % of family income	$78-$18,306 / 0%-12%
Type 2 diabetes costs, % of family income	$76-$10,014 / 0%-7%

Impact of Diabetes

• Among Canadians (1):
  • 30% live with diabetes or prediabetes;
  • 10% live with diagnosed diabetes, a figure that climbs to 15% 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 20% of their gross annual income on medications and devices that range from $78 to $18,306.
  • Those living with type 2 diabetes can pay up to 16% of their gross annual income on medications and devices that range from $76 to $10,014.

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 June 2023, the Federal Government announced nearly $1 million dollars over three years to allow Diabetes Canada to begin the work of implementing the recommendations and strategies laid out in the Framework for Diabetes in Canada.
• In October 2022, the Federal Government tabled the Framework for Diabetes in Canada.
• In 2022, the Federal Government expanded access to the Disability Tax Credit (DTC) for Canadians with type 1 diabetes and type 2 using insulin applying under Life-Sustaining Therapy. Effective tax year 2021, applicants with type 1 diabetes are no longer required to prove they spend at least 14 hours per week on activities related to administering insulin and those with type 2 using insulin can include carbohydrate counting in their calculation of activities.
• In June 2021, Bill C-237, An Act to Establish a National Diabetes Framework, became law in Canada. This requires the Federal Minister of Health to undertake stakeholder consultations to develop a national framework designed to support reducing the risk for type 2 diabetes and improved treatment for all people living with diabetes.
• Budget 2021 committed $35 million over five years for diabetes research, surveillance, prevention, innovation, and the development of a comprehensive diabetes framework.
• Budget 2021 also included enhancements to the Disability Tax Credit by expanding the list of permitted activities that can be counted towards the 14 hour per week eligibility criteria under Life-Sustaining Therapy.
• In 2016, Health Canada announced its Healthy Eating Strategy, which aims to improve the food environment and decrease the risk of chronic diseases, including type 2 diabetes, by:
  • Supporting healthy eating through the revision of Canada’s Food Guide;
  • Restricting the marketing of unhealthy foods and beverages to children;
  • Strengthening labelling and claims to make it easier for Canadians to identify foods high in sugar, saturated fat, and salt;
  • Working with manufacturers and restaurants to reduce sodium and trans fats in food; and
  • Increasing access to, and availability of, nutritious foods through its Nutrition North program.
• In 2016, a Parliamentary All-Party Diabetes Caucus was convened and meets at least twice a year to advocate for diabetes issues within Parliament, in partnership with Diabetes Canada.

Canada faces unique challenges in preventing type 2 diabetes and meeting the needs of people living with diabetes:

• Non-modifiable risk factors of type 2 diabetes include age, gender, and ethnicity (11).
  • The number of adults aged 65 years and older in Canada exceeds the number of children (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 30% of Canadians 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 approximately 1.7 million Indigenous people in Canada, who face significantly higher rates of diabetes and adverse health consequences than the overall population (16).
• Canada has high rates of individual-level modifiable risk factors (17):
  • 17.6% of Canadian adults are current tobacco smokers.
  • 70.7% of Canadian adults are not eating enough fruits and vegetables; and
  • 35.9% of adults are living with overweight and 26.7% of adults are living with obesity;
  • 42.8% of adults and 76.5% of youth aged 12-17 are physically inactive;
• Factors related to the social determinants of health and that can influence the rate of modifiable behavioural risk factors among Canadians include income, education, food security, the built environment, social support, and access to health care (3).

1. Adequate Resources: Fund innovative models such as cost sharing, matched funding programs, and public/private partnerships to ensure provinces,