Follow Us On Twitter     |     Contact     |     McGill     |     IHSP


Diabetes and Healthy Lifestyles


1 April 2014

Over the past decade, diabetes prevalence in Canada has been increasing steadily and the burden of diabetes has proven a substantial burden on the health of Canadians, the healthcare system, and the national economy. The Canadian Diabetes Association (CDA) has estimated that, in 2010, the economic burden of diabetes in Canada equaled $11.7 billion, and as diabetes prevalence continues along its current upward trend, so too will the costs associated with the disease. The majority of this burden is linked to the incidence of type II diabetes, which accounts for 90-95% of diabetes cases, and is strongly linked to modifiable risk factors such as diet and exercise.

In order to better understand the relation between diabetes prevalence and healthy lifestyles in Canada, we have examined data from Canadian Community Health Surveys between the years 2000 and 2012. The results provide both cause for concern and reason for optimism.

Diabetes Prevalence in Canada (2000-2012)

Between the years 2000 and 2012, the proportion of respondents to the Canadian Community Health Survey indicating that they have been diagnosed with diabetes increased by 53.7%, from 4.1% of respondents in 2000-2001 to 6.3% in 2011-12. And such estimates are certainly lower than actual diabetes prevalence, as they do not account for undiagnosed cases of the disease.1

Over the same period, diabetes prevalence grew by 83.5% across the Yukon, Nunavut and Northwest Territories, by two-thirds in Nova Scotia, and increased by more than 50% in all but one province, British Columbia. Diabetes prevalence in highest in the Atlantic provinces, with Prince Edward Island (7.6%), New Brunswick (8.0%), Nova Scotia (8.6%), and Newfoundland and Labrador (9.4%) each exhibiting reported diabetes prevalence exceeding the national average (6.3%). Reported prevalence is lowest in the northern territories, although, in the previous decade, this region has also exhibited the highest rate of growth in diabetes prevalence.

Apart from the apparent geographic dimension of diabetes in Canada, diabetes has also had a disproportionate impact on specific populations, such as immigrants, and low-income Canadians. In 2012, immigrants were nearly 35 percent more likely than non-immigrants to be diagnosed with the disease (7.8% compared to 5.8%), and 10.1% of those with a household income below $40,000 had been diagnosed with the disease, while the same was true of only 4.3% of those with household incomes above $60,000

Diabetes and Healthy Weights

Turning to risk factors associated with the onset of diabetes, we find that as diabetes prevalence has increased, so too has the proportion of Canadians that are either overweight or obese. According to CCHS, between the years 2000 and 2012, the proportion of Canadian adults who were either overweight or obese has grown from 48.5 percent to 52.3 percent, based on self-reported heights and weights. There has also been a noticeable increase, over the same period, in the proportion of Canadian adolescents (those between the ages of 12 and 17) that are either overweight or obese – from 19.4% to 21.1%. And while these trends are themselves troubling, further evidence estimates that the proportion of Canadians that are overweight or obese is actually quite higher than this data suggests; the Canadian Diabetes Association and Statistics Canada estimate that 61% of Canadians are overweight or obese.2

Diabetes and Healthy Lifestyles

Given the increasing prevalence of both diabetes and obesity over the previous decade, we might also expect to observe declines in related lifestyle factors such as healthy eating and levels of physical activity. While the fact that such declines are not evident among CCHS survey responses does represent reason for optimism, the broader picture is a bit more troubling.

Dietary Habits

Daily consumption of fruits and vegetables has remained relatively constant over the period from 2000 to 2012, with the mean number of fruits or vegetables consumed daily by respondents in fact increasing slightly from 4.7 in 2000-2001 to 4.8 in 2012.

Additionally, respondents over this same period also indicated that they were becoming more discerning in their dietary choices – the proportion of survey respondents indicating that they avoid certain foods because of health concerns increasing from 56.7% in 2000-2001 to 66.1% in 2012, and the proportion of respondents indicating they avoided foods for content reasons increasing from 71.0% to 81.4%.

Yet, even though these data indicate that Canadians’ dietary habits have improved over this period, on average, Canadians still consume less than the recommended minimum of five servings of fruits or vegetables daily, and only 40.5% of respondents reported actually meeting this recommended minimum.

Physical Activity

The CCHS also contains a battery of questions on physical activity that are subsequently compiled into a “physical activity index”. These data indicate that the proportion of those classified as either “active” or “moderately active” increased between 2000-01 and 2011-12 from 46.5% to 53.9%, while the proportion of those classified as “inactive” has decreased from 53.5% to 46.2%.

Again, while these data indicate that Canadians are becoming more active, nearly one-half of Canadians continue to maintain inactive lifestyles, thus increasing their risk of developing Type II diabetes.

Although evidence indicating that Canadians are, on average, leading increasingly healthy lifestyles does represent some cause for hope, the large proportion of Canadians that are either inactive or failing to meet the recommended daily intake of fruits and vegetables remains reason for concern. Evidence of improvement in levels of physical activity and fruit and vegetable consumption must also be approached with some caution. As with the self-reporting of weight, data based on self-reported dietary habits and physical activity may be influenced by respondent bias – stemming either from inaccurate self-assessment, or a tendency toward providing socially desirable responses. While it’s possible that small steps have been made in the right direction, there is still much more progress to be made before the growth of diabetes prevalence in Canada can be slowed.

1 All results referring to either diabetes prevalence or diabetics include all types of diabetes, including type-i diabetes and gestational diabetes. It should be noted that throughout the the entire period for which such data is available in the CCHS (2004-2012), the proportion of total diabetes incidence accounted for by type-ii diabetes remained relatively constant at ~95%.
2 Canadian Diabetes Association, 2011, Diabetes: Canada at the Tipping Point: Charting a New Path.

Unless otherwise noted, all data contained herein is drawn from the Canadian Community Health Survey (CCHS) 2000/01-2011/12. The CCHS is a joint effort of Health Canada, the Public Health Agency of Canada, Statistics Canada, and the Canadian Institute for Health Information (CIHI).