As global diabetes rates rise, the prevalence of the disease in Canada has stabilized in recent years, with women seeing the most progress, new research suggests.
But experts say “it’s still really an epidemic” that needs greater attention.
A peer-reviewed study published in The Lancet journal on Wednesday ahead of World Diabetes Day showed that between 1990 and 2022, age-standardized diabetes rates neither increased nor decreased in Canada.
Worldwide, an estimated 828 million people were living with diabetes in 2022 and the global rate of the disease – Type 1 and 2 combined – in adults doubled from seven per cent to 14 per cent over the last three decades.
In Canada, there were 1.2 million women and 1.8 million men living with diabetes in 2022, data showed.
With a 5.7 per cent prevalence rate, Canada ranked 15th in the world when it comes to diabetes in women and with an 8.1 per cent prevalence, Canadian men ranked 35th globally.
“It gives us an idea that compared to other similar countries around the world, Canada’s doing a little bit better,” said Calvin Ke, an assistant professor at the University of Toronto and study co-author.
However, with an aging population driving cases up each year and diabetes still affecting one in 10 people in the country, it’s not all good news for Canada, experts say, adding that more needs to be done to improve rates of diagnosis and prevention.
Lorraine Lipscombe, an endocrinologist at the Women’s College Hospital in Toronto who is also on Diabetes Canada’s national research council, said the Lancet study does not paint a full picture of diabetes prevalence in Canada because of undercounting and bias.
“My concern about these numbers is that they are likely a little bit undercounting because of the way in which the data were collected,” she said.
Jeremy Gilbert, an endocrinologist in Toronto, said the Canadian data is encouraging, but diabetes is “still really an epidemic.”
Why are diabetes rates plateauing in Canada?
There are several factors that could be contributing to diabetes rates plateauing in Canada, experts say, but more research is needed.
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Diet and physical activity play a role in minimizing the risk of developing diabetes, Ke said.
Better awareness and screening could also be behind the flattening rates, Lipscombe said.
“One piece of good news is that more people are likely being screened and tested for diabetes than before and there’s greater awareness in our population about diabetes,” she said.
Gilbert said despite increased awareness of the importance of diet and exercise, people are more sedentary in their lifestyle and eating healthy is more expensive than eating unhealthy foods like processed meals or those high in sugars, fats or salts.
“We tell people to eat vegetables and proteins, but those are the most expensive of the foods,” he said.
“I think we’re seeing signs of some raised knowledge and awareness, but still a lot of work to do on the implementation side of things.”
Are Canadian women seeing most progress?
The Lancet study found that the lowest prevalence of diabetes in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women.
Ke said in most countries there’s a higher rate of diabetes among men compared with women.
While the Lancet study did not look at the factors behind gender differences, Ke said other research suggests that obesity among women is lower in Canada than in other countries, such as the United States.
Dietary factors and gender-related factors that are unique to Canada could also be playing a role, he said.
Age increases the likelihood of diabetes and risk factors, like unhealthy lifestyles, are traditionally more common in older men, Lipscombe said.
Biological factors could also be protecting women from diabetes when they are younger.
“Having estrogen, for example, has been shown to be somewhat protective,” Lipscombe said.
She said even though overall men are more likely to be diagnosed with diabetes, in the younger age group under the age of 50, women are catching up, with an equal likelihood of getting diabetes as younger men.
Meanwhile, there has also been a significant rise in gestational diabetes during pregnancies in Canada, which is a “worrisome trend,” Lipscombe said.
Gilbert questioned the gender discrepancy in the Lancet research, saying it’s inconsistent with previous studies.
“I have a large practice, but I have a large number of women and men and Canadian data in the past has always showed very similar prevalence of men and women with diabetes.”
When it comes to treatment coverage, Canada was among the countries to see the biggest improvement over the past three decades, along with Mexico, Colombia, Chile, Costa Rica, South Korea, Russia, Seychelles and Jordan.
Ke said around two-thirds of diabetes patients above the age of 30 are being treated in Canada, which is a “good sign,” but there’s still “a large gap” that needs to be filled to improve access to treatments, especially in the more vulnerable population.
Lipscombe said Canada’ universal health-care system gives it an advantage over other countries when it comes to accessing care and recommending treatment for diabetes.
She is optimistic that Canada’s pharmacare bill, which became law last month and includes coverage of diabetes medications for all Canadians, will only further improve treatment access.