Good afternoon, Madam Chair and members of the committee.
On behalf of the Canadian Diabetes Association, thank you so much for inviting us here today. We are very pleased to join in this discussion concerning those chronic diseases related to aging.
Given Canada's aging population, this study will be essential in the development of policy to care for our senior citizens, many of whom find themselves in vulnerable circumstances due to living with one or more chronic diseases, including diabetes and its related complications. Our remarks here today will focus on the impact of diabetes and its complications on our health care system, our economy, and those living with the disease.
The Canadian Diabetes Association leads the fight against diabetes by helping people with diabetes lead healthy lives while we work to find a cure. Established more than 50 years ago, we are a not-for-profit that has a presence in communities across Canada and we work with a strong nationwide network of volunteers, employees, health care professionals, researchers, partners and supporters. The association promotes the health of Canadians through education and services advocating on behalf of people living with diabetes, supporting research, and translating research into practical applications.
Unfortunately, diabetes is an epidemic in Canada and worldwide. The increasing prevalence of diabetes is dramatic and alarming. In 2010, 7.6% of Canadians, or 2.7 million people, had diabetes. If no action is taken by 2020, almost 11% of Canadians, or over four million people, will have diabetes. In addition, almost one million people have diabetes but don't know it because they have not yet been diagnosed. As well, over seven million people have pre-diabetes, which, if left unchecked, puts them at risk for developing type 2 diabetes.
Today more than nine million people are living with diagnosed or undiagnosed diabetes or pre-diabetes. This means that one in four Canadians is living with either pre-diabetes or diabetes. If those figures weren't alarming enough, by 2020 it will be one in three Canadians unless action is taken to stem this epidemic.
There is a strong link between age and type 2 diabetes, which comprises approximately 90% of diabetes cases. In fact, the likelihood of developing diabetes increases substantially with age. Our clinical practice guidelines generally note that being over 40 years of age and older is one of the key risk factors for developing type 2 diabetes. This is critically important, since, according to Statistics Canada, by 2036 the number of seniors in this country will more than double, to approximately 25% of the population, outnumbering children for the first time.
In addition to an aging population, rising rates of unhealthy weight and sedentary lifestyles, as well as a change in the ethnic mix of Canadians, are all drivers of the alarming increase in the prevalence of diabetes.
Given the relationship between aging and diabetes, it is no surprise that most Canadian provinces with median ages older than the national average have higher rates of diabetes, in particular, Atlantic Canada. For example, Newfoundland and Labrador has the highest median age in Canada, and also the highest rate of diabetes and pre-diabetes. By 2020, while the national prevalence rate for diabetes will approach 11%, in this province it will surpass 14% if action is not taken.
With increasing diabetes prevalence comes an increasing cost, affecting our health care system and our economy. Diabetes currently costs more than $11.7 billion in Canada and will rise to $16 billion by 2020. It's also important to point out that 80% of these costs are due to diabetes-related complications such as heart attack, stroke, kidney disease, blindness, amputation, and depression. These conditions are commonly found among elderly Canadians with diabetes, since the likelihood of developing these complications increases the longer a person has the disease.
Diabetes also costs those living with the disease. With the exception of those living on very low incomes and covered by government support, out-of-pocket costs can approach or surpass $2,000 for type 2 diabetes across income levels and provinces and territories. For those with type 1 diabetes, these costs can be even higher, especially if they use an insulin pump. These costs continue to be a barrier to effective self-management of diabetes. Over half of Canadians with type 2 diabetes indicate that they do not comply with their prescribed therapy due to the cost of medications, devices, and supplies, leaving them vulnerable to complications, which can be life-threatening.
These costs do effect the elderly. Our members who can currently afford these costs have expressed their very serious concern that they may have to compromise their self-management when they retire due to these costs.
We need to reduce the burden of diabetes and related complications. In order to do this, the Canadian Diabetes Association recommends enhanced diabetes prevention and management for elderly Canadians. Lifestyle interventions are effective in the prevention of diabetes in the elderly at high risk for the disease, including moderate weight loss and regular physical activity.
Since diabetes in the elderly is metabolically different, their management and/or therapy should reflect this. Support from health care teams, including doctors, nutritionists, dieticians, pharmacists, diabetes nurse educators, etc., have been shown to improve glycemic control in the elderly.
Nutrition education and exercise combined with medication should be carefully tailored to suit the needs of the elderly and the various sub-populations, such as those at increased risk of hypoglycemia, which is a lower-than-normal blood glucose level.
We also need to address not only the physical health needs, but the mental health needs of elderly people with diabetes. According to the Canadian Mental Health Association, depression in seniors is extremely common. Many challenges they face contribute to depression, including reduced functional ability due to physical illness, mobility impairment, chronic pain, and cognitive and sensory impairment. Other challenges, such as retirement, changes in income, widowhood, the death of friends, and new caregiving responsibilities, can lead to social and emotional isolation. This is particularly important, given that people with diabetes across the board are as twice as likely to be depressed compared to those without the disease, compromising their ability to self-manage.
People with diabetes who develop related complications such as depression are less likely to follow diet and exercise recommendations, check their blood glucose levels, or fill their prescriptions for diabetes and complications. So if you are elderly and have diabetes, your risk of depression and other serious complications is that much higher.
The increasing senior population has also led to dramatic increases in the number of seniors in long-term-care facilities. Seniors in these facilities often have undiagnosed diabetes and related complications, such as mental health disorders. Under-nutrition is also a major problem in these establishments.
In summary, the risk of developing type 2 diabetes and diabetes-related complications is higher for elderly Canadians. Diabetes currently costs Canada more than $11.7 billion, and 80% of this cost is due to diabetes-related complications.
With a growing senior population we must focus on keeping elderly Canadians with diabetes healthy to avoid or delay costly complications, and address the impact of diabetes on our health care system and economy.
Lifestyle interventions are effective in preventing diabetes in the elderly who are at risk for developing the disease. Elderly people with diabetes should have a health care team that provides education and support.
Given that elderly Canadians are vulnerable to both diabetes and depression, measures to address their needs should focus on both physical and mental well-being.
Finally, successful chronic disease prevention and management to support healthy aging starts long before age 65. We invite you to consult our recommendations to stem the course of diabetes in Canada within the Diabetes: Canada at the Tipping Point report released in April, contained within your information packages.
Thank you once again for the opportunity to convey our views today on this important issue. We'd be pleased to answer any questions you may have.