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Diabetes in Canadian Women

Catherine Kelly, MSc, MD, FRCPC and Gillian L. Booth, MD, MSc, FRCPC (University of Toronto)

Health Issue

Diabetes mellitus (DM) is a chronic health condition that affects approximately 4.8% of Canadian adults 20 years of age and older. The prevalence increases dramatically with age; approximately 12% of Canadians aged 60.74 years are affected, according to the National Diabetes Surveillance System (NDSS) (1998-1999). As many as one-third of cases may remain undiagnosed. The number of people with DM is projected to increase substantially over the next 20 years, largely as a result of increases in rates of obesity and inactivity, as well as the aging of the population. This chapter reviews data from the NDSS, the 2000-2001 Canadian Community Health Survey, Ontario Diabetes Database (1998-1999), and the Ontario Health Survey II to investigate DM and the factors associated with it.

Key Findings

Determining the true prevalence rates of DM remains a difficult task. Administrative databases provide important information, but people who do not seek medical attention or whose condition is undiagnosed will not be captured in these statistics. Self-reporting on population surveys is also known to underestimate actual rates of disease. Diabetes mellitus in Canada appears to be more common among men than women in almost every age group. The sole exception to this is women aged 20-34 years who have higher rates of the disease. These are reproductive years when women have more physician visits and are more likely to be diagnosed if they have diabetes.

Among Aboriginal Canadians, DM is much more prevalent among women, who represent two-thirds of affected individuals. Diabetes mellitus is also more prevalent in other ethnic groups, including South or West Asians, African Canadians, and Hispanic populations. Obesity and inactivity are well-described risk factors. Although the prevalence of obesity is higher among Canadian men than women (35% versus 27%), the risk of DM associated with excess weight is relatively greater among women. Socio-economic status appears to be inversely related to the prevalence of DM. Women aged 20-65 with household income under $20,000 are twice as likely to have DM as those with higher income levels. Income-related disparities in DM prevalence are greater among women. Polycystic ovarian syndrome, an endocrine disorder that affects 5.7% of women of reproductive age, is associated with a doubled risk of DM. The prevalence of depression among women with DM is twice that of women without DM and is associated with poor metabolic control and the use of more health care resources.

Data Gaps and Recommendations

The authors identified the following data gaps and made the following recommendations:

• There is inadequate information about DM as it relates to ethnic/racial groups other than Aboriginal Canadians and Canadians of European ancestry, and about the chronic complications of DM by gender and in women of these other ethnic groups.
• The reasons for the greater income-related disparities in DM prevalence among women remain unclear. Qualitative and quantitative research on lower-income women who have DM is needed to evaluate ethnic/racial differences, social supports, marital status, housing information, family structure, number of dependent children, employment status, lifestyle and activity profiles, dietary habits, health beliefs, and depression. Obtaining more detailed information about these women might help to elucidate factors that could be modifiable and thus potentially improve health outcomes. Depression is almost twice as prevalent among women with DM than it is among women who do not suffer from the disease, and influences a woman's ability to achieve good metabolic control. Research to determine whether more aggressive treatment of depression and/or mood disorders improves DM metabolic control could have a significant impact on health outcomes.
• Rising obesity rates in Canadian children of all ethnic groups is sounding an alarm for an impending rise in type 2 DM among children. Policies to promote healthy lifestyles among Canadians of all ages are urgently required.
• From pre-school throughout high school, school systems across the country need to examine the amount of time devoted to physical education and health promotion. Many high schools have eliminated or limited compulsory physical education classes (or an alternative activity), resulting in less active lifestyles for students. Government and public pressure to encourage schools and fast food outlets to serve healthier foods in smaller portions should be encouraged.
• Lifestyle promotion programs for adults, particularly in the workplace, should be studied. Canadians are working longer hours than they did 15 years ago, making it difficult to find adequate time outside of normal work hours for sports or other activities.
• There is a need to adress the disparities in access to supplies (e.g. medications, blood glucose testing supplies) and services by low income people with DM across the country.
• Aboriginal women are at particular risk of developing obesity and type 2 DM. Culturally sensitive community programs need to be planned, implemented, and evaluated in this population.
• Women who have gestational diabetes are known to be at significant risk of developing type 2 DM in the future. It seems prudent to target these young women for diabetes prevention programs in their communities and monitor the outcomes of such programs. Large prospective trials have demonstrated that lifestyle interventions are extremely effective in preventing the progression to DM among high risk populations.
• Canadian health professionals need further training in the use of effective counselling skills that will assist people with DM to make and maintain some difficult behavioural changes.

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