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With global diabetes rates rising, the disease's prevalence in Canada has stabilized in recent years, with women seeing the most progress, new research shows.
But experts say “it's still really an epidemic” that needs more attention.
A peer-reviewed study published in The Lancet Journal Wednesday ahead of World Diabetes Day, it emerged that between 1990 and 2022, age-standardized diabetes rates in Canada neither increased nor decreased.
An estimated 828 million people worldwide were living with diabetes in 2022, and the global rate of the disease – Types 1 and 2 combined – in adults has doubled from seven percent to 14 percent over the past thirty years.
In Canada, 1.2 million women and 1.8 million men were living with diabetes in 2022, data showed.
With a prevalence of 5.7 percent, Canada ranks 15th in the world for diabetes in women, and with a prevalence of 8.1 percent, Canadian men rank 35th globally.
“It gives us the idea that Canada is doing a little bit better, compared to other comparable countries in the world,” said Calvin Ke, an assistant professor at the University of Toronto and co-author of the study.
But with an aging population causing cases to rise every year and diabetes still affecting one in 10 people in the country, it's not all good news for Canada, experts say. They add that more needs to be done to improve diagnosis and prevention rates.
Lorraine Lipscombe, an endocrinologist at Women's College Hospital in Toronto who is also a member of Diabetes Canada's national research board, said the Lancet study does not paint a complete picture of the prevalence of diabetes in Canada due to undercounting and bias.
“My concern about these numbers is that they are probably a little bit too low because of the way the data was collected,” she said.
Jeremy Gilbert, an endocrinologist in Toronto, said the Canadian data is encouraging, but diabetes is “still very much an epidemic.”
Why are diabetes rates falling in Canada?
There are several factors that could be contributing to diabetes rates falling 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 leveling off rates, Lipscombe said.
“One piece of good news is that there are probably more people being screened and tested for diabetes than before and there is greater awareness among our population about diabetes,” she said.
Gilbert said that despite increased awareness of the importance of diet and exercise, people are becoming more sedentary and eating healthy is more expensive than eating unhealthy foods such as processed meals or foods high in sugars, fats or salts.
“We tell people to eat vegetables and protein, but those are the most expensive foods,” he said.
“I think we're seeing signs of some increased knowledge and awareness, but there's still a lot of work to do on the implementation side.”
Are Canadian women seeing the most progress?
The Lancet study found that the lowest prevalence of diabetes in the world in 2022 for both sexes was in Western Europe and East Africa, and for women in Japan and Canada.
Ke said the prevalence of diabetes among men is higher than among women in most countries.
Although the Lancet study did not look at the factors behind gender differences, Ke said other research shows obesity among women in Canada is lower than in other countries such as the United States.
Dietary and gender-related factors unique to Canada may also play a role, he said.
Age increases the risk of diabetes and risk factors, such as an unhealthy lifestyle, are traditionally more common in older men, Lipscombe said.
Biological factors can also protect women from diabetes when they are younger.
“For example, having estrogen has been shown to be somewhat protective,” Lipscombe said.
She said that while men are generally diagnosed with diabetes more often, women in the younger age group under 50 are catching up, with an equal chance of developing diabetes as younger men.
Meanwhile, Canada is also seeing a significant increase in gestational diabetes during pregnancies, which is a “worrying trend,” Lipscombe said.
Gilbert questioned the gender discrepancy in the Lancet study, saying it is inconsistent with previous studies.
“I have a large practice, but I have a large number of women and men and past Canadian data has always shown a very similar prevalence of men and women with diabetes.”
When it comes to treatment coverage, Canada was among the countries that have seen the greatest improvement in the past 30 years, along with Mexico, Colombia, Chile, Costa Rica, South Korea, Russia, the Seychelles and Jordan.
Ke said about two-thirds of diabetes patients over the age of 30 are receiving treatment in Canada, which is a “good sign,” but there is still “a big gap” that needs to be filled to improve access to treatments, especially in the more vulnerable population.
Lipscombe said Canada's 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 Pharmacy Act, which came into effect last month and includes diabetes drug coverage for all Canadians, will only further improve access to treatments.
Saba Aziz
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