New Map Reveals Diabetes Hot Spots in the GTA

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Written by: Megan Ogilvie

TUESDAY, April 24th 2012 (Toronto Star) — More than 1 million Ontarians have diabetes and the Greater Toronto Area is home to approximately one half of all cases, a massive new study has found.

Brampton, parts of Mississauga, Etobicoke, Rexdale and Scarborough have some of the highest rates in the province — with the exception of First Nations communities, where as many as one in three people have diabetes.

The report released Tuesday by the Institute for Clinical Evaluative Sciences (ICES), for the first time maps diabetes rates cross Ontario. It also plots rates of diabetes complications, painting a picture of who in the province is more likely to receive help in managing their disease.

Previous reports have shown some communities in the GTA have higher than average rates of diabetes. But the new data reveals rates in several areas are even higher than some experts anticipated.

In Brampton, Malton and Rexdale, for example, between 12 and 22 of every 100 adults have diabetes. The provincial average is about 9 cases for every 100 adults.

“It’s definitely an increase from previous numbers,” Dr. Sanjeev Goel, the diabetes primary care lead for the Central West Local Health Integration Network, said of the rates in Brampton, Malton and Rexdale. “It is surprising they are that high. That means, in some parts of those communities, one in five people have diabetes.”

The goal of the ICES study is to provide a baseline look at patterns of diabetes in Ontario to help policy makers and healthcare practitioners better target diabetes prevention and management strategies to communities that need them most.

Although the data in the report did not differentiate between type 1 and type 2 diabetes, the majority of people with diabetes — about 90 to 95 per cent — are thought to have type 2, said the study’s lead author, Dr. Gillian Booth, an adjunct scientist at ICES and a scientist at the Centre for Research on Inner City Health at St. Michael’s Hospital. 

Type 1 diabetes, which most often appears when the patient is a child or teenagers, should not be confused with type 2 diabetes, in which the body does not produce enough insulin or uses insulin efficiently. Type 2 diabetes, which is closely tied to obesity, is a chronic disease that comes with myriad health complications, including stroke, heart disease, blindness and kidney disease.

Experts say the soaring rate of type 2 diabetes in Ontario — and across much of the world — is due in part to an aging population and to rising rates of obesity, spurred on by unhealthy eating habits and sedentary lifestyles.

But socioeconomic status and ethnic background also play a part in who will get diabetes and who is at risk for developing the disease.

Booth said diabetes is more common in certain ethnic groups, including people of Aboriginal, South Asian, African and Hispanic descent. These groups are more likely to get type 2 diabetes — and at an earlier age — due to a variety of genetic factors, including a propensity to gain weight and the likelihood that extra body fat will induce insulin resistance.

Booth said the pattern revealed by the report fits with where these at-risk communities live in the province.

“There is more ethnic diversity in the GTA, so we do see higher rates of diabetes as well,” she said. “Amongst recent immigrants, South Asians have among the highest rates of diabetes. We do see communities around the GTA, such as Brampton and Mississauga, having high rates of diabetes where we know a lot of South Asian immigrants are settling.”

Zacky Ahsan, 58, has had type 2 diabetes for 13 years. The Brampton resident of South Asian descent admits he did not manage his diabetes as well as he could after his diagnosis. In April 2011, Ahsan suffered a diabetes-related stroke and spent two months recovering in hospital.

“I learned my lesson,” said Ahsan, who immediately quit smoking and is now vigilant in monitoring his blood-sugar levels, taking his medications and keeping to an appropriate diet. He also volunteers with the Canadian Diabetes Association to educate as many people as possible in his community about ways to manage the disease to prevent complications.

“The majority of people are not aware of what will happen,” he said. “This is the only disease that affects the whole body — the renal system, the pancreas, the eyes, the limbs.”

Mimi Lowi-Young, CEO for the Central West Local Health Integration Network (LHIN), said the LHIN has known about the high rates of diabetes within its boundaries since being alerted by the 2006 Canada Census.

“We know we’ve got a very fast-growing population, especially of the South Asian population; we also have an aging population and we have a population who has increased obesity,” she said. “You put that all together and those are some of the factors that cause us to have a higher rate of diabetes.”

To help the thousands of residents with diabetes, the LHIN has 11 diabetes education programs scattered across the region and has opened a Centre for Complex Diabetes Care at Brampton Civic Hospital, which Lowi-Young said provides individuals with diabetes “a single point of access to help slow the process of their disease.”

Key findings

 • More than two-thirds of Ontarians with diabetes live in major urban centres.

 • In northern and rural First Nations communities, diabetes prevalence among adults is as high as 32 per cent.

 • Rates of chronic complications of diabetes, which include end-stage kidney disease, amputation and cardiovascular problems, were highest in northern Ontario and in rural areas in southern parts of the province. Rates for those communities were about three times higher than in urban areas.

 • Rates of acute complications, which include severe high or low blood sugar levels, varied four-fold across the province. Rates for these complications were highest in smaller, rural communities in southern and northern areas of Ontario.

 • People in urban areas had greatest access to diabetes programs and services.

 • More than half of Ontarians with diabetes had an additional chronic medical condition.