My Address to the Canadian Diabetes Association Greater Toronto Area inaugural Flame of Hope Golf Tournament
Ladies and gentlemen:
Thank you very much for giving me the opportunity this evening to address the Canadian Diabetes Association Greater Toronto Area inaugural Flame of Hope Golf Tournament.
My name is David Kaplan. I’m a family physician who works in Toronto. I’m also the primary care lead for the Central Local Health Integration Network regional diabetes coordination centre. The central LH I N is the regional authority responsible for planning and funding the health care system from the 401 up to Lake Simcoe.
Approximately 2 1/2 years ago the Ontario government announced their Ontario diabetes strategy. As part of that strategy the government created Diabetes Regional Coordination Centre in each of the LHINs,
In the next 7 minutes or so my hope is to outline some of the great work that the RCCs are doing in Ontario. Much of the work we do is supported and partnered with the Canadian Diabetes Assocation and the Strategy benefits greatly from your philanthropic contributions. However, my main message this evening is that the treatment of diabetes cannot be our sole focus.
The increasing incidence of Diabetes in Ontario has been and will continue to be a failure of our public health strategy — –Unless we make changes to the way we educate our children and young people.
It is not about preventing disease, it’s about giving them the tools for them to lead healthy lifestyles. This is not about medicine — this is about what our moral obligation is to our children.
Over the past two years of implementing the Ontario Diabetes Strategy, the government has built on existing investments in prevention and care initiatives at each level of the health system to build capacity, make it easier for people to get the services they need and improve the overall quality of diabetes service and care in Ontario.
Ontario has set targets and is tracking progress in its fight against diabetes:
These targets include:
Ensuring all people with diabetes have access to a primary health care provider.
Ensuring that 80 per cent of people with diabetes, aged 18 and older have all three diabetes tests, cholesterol, a retinal eye exam and the HbA1C test (a measure of blood sugar control) within the recommended guideline period for optimal diabetes management.
Having 35 per cent of all dialysis patients receive their dialysis at home.
Ensuring that the Insulin Pumps and Supplies Program for Adults meets its target of 1,342 new approved applicants for funding for insulin pumps and supplies.
Increasing the number of annual bariatric surgeries to 2,085 a year by 2011/2012.
Through Baseline Diabetes Dataset Initiative, physicians are provided with information about the numbers and proportion of diabetes patients in Ontario who have received three key tests,blood glucose control(HbA1C),cholesterol (LDL-C),and a retinal eye exam within the intervals recommended by clinical practice guidelines. The Diabetes Testing Reports helps inform primary care providers about their own patients’ compliance with the three key tests, letting them know which of their patients might need to be reminded.
These targets only address the million Ontarians who already suffer from Diabetes. What is waiting for us over the next decade is a tsunami of patients who will develop Diabetes.
Many of these future diagnoses are preventable.
51.2 Percent of Ontarians who are physically inactive
51.7% of Ontarios are overweight or obese
According to Lipscombe and Hux, the age- and sex-adjusted diabetes prevalence in Ontario increased from 5.2% 1995 to 8.8% 2005. Diabetes prevalence increased by one third during the first five years and by an additional quarter during the second five years. The good news is that based on the work of HCPs and the CDA, the adjusted mortality rate for diabetics has fallen by 25% over the 10-year period studied. Importantly, however, while diabetes rates have been higher in older men and women (50 or older), the rate of increase has been steeper in younger Ontarians, aged 20 to 49 years.
Today 9.3% of Ontarios have diabetes. That is approximately 1 million people.
As I have suggested, our goal must be prevention.
Studies on diabetes prevention programs shows that people at risk for developing diabetes can prevent or delay the onset of diabetes by losing a modest amount of weight through diet and exercise. DPP participants in the lifestyle intervention group reduced their risk of developing diabetes by 58 percent during the study.
DPP participants who took the oral diabetes medication metformin also reduced their risk of developing diabetes, but not as much as those in the lifestyle intervention group.
But again, these people already are at risk of developing diabetes.
We must focus future investements on prevention strategies that have been shown to work.
the combination of a car-friendly culture and popular sedentary activities like watching TV or playing video games make it unsurprising that at least 25 per cent of Canadians between the ages of two and 17 are overweight, according to Statistics Canada.
A few years ago, the Canadian Medical Association Journal reported that the average Canadian kid spends three to five hours a day sitting in front of a TV or computer screen. The study also showed that in the past 15 years, the incidence of obesity has grown by more than 50 per cent in children age 6 to 11 and by 40 per cent in those between the ages of 12 and 17.
Canada’s Physical Activity Guide advises children to aim for 90 minutes a day of physical activity.
Yet, The Active Healthy Kids Canada 2009 Report Card found that only 13 per cent of the country’s children and youth were getting 90 minutes of physical activity a day. The organization says besides the health benefits of physical activity, its research shows that active kids do better in school than sedentary kids.
I suggest tonight that we make to following changes in Ontario
1. Children’s work is play ! We must increase physical activity through unstructured activity and access to play equipment. This may come at the expense of Grade three test scores.
2. Parents are the role models for their children – not school. Parents must be taught that they act as role models of an active lifestyle for their children.
This would involve: Limiting television and computer time to less than two hours per day to reduce a child’s sedentary time. We need to reduce our screen time, especially in front of our children. This is really about changing a whole family’s lifestyle.
3. Teach healthy eating. Practical healthy eating. Meal planning. Culturally sensitive meal planning and portion sizes.
We have made great strides in the treatment of diabetes and the prevention of diabetes-related complications. Again, for that I thank you for your philanthropy.
My message to each of you tonight is that we need to focus on prevention. Preventing this disease is doable. It is the quintessential shift from disease treatment to disease prevention. We owe it to ourselves and to our children.