Q&A with diabetes expert

Q: What is the prevalence of diabetes/pre-diabetes in Canada?

A: It’s estimated that between eight to 10 per cent of Canadians have diabetes. It is harder to quantify the prevalence of pre-diabetes as it is often not diagnosed, but Diabetes Canada estimates that as many as one in four Canadian adults either has diabetes or pre-diabetes.

Q: Are there symptoms to watch out for?

A: People with fairly advanced diabetes and very high blood sugars will begin to develop symptoms that include: fatigue, blurred vision, frequent urination, unquenchable thirst, and urinary tract infections/yeast infections. However, most cases are silent and have no symptoms, so the only way to find out is to have a blood test ordered by your doctor.

Q: What is the impact of diabetes on a patient’s heart health?

A: Diabetes is considered a “cardiovascular risk equivalent.” What this means is that people who live with diabetes are at the same risk of having heart attacks and strokes as someone who has previously had one of those conditions. This risk can be lowered by keeping blood sugars in check with medications, dietary modifications and physical activity.

Q: What about their quality of life?

A: People with advanced diabetes can also be affected by damage in many other places, not just the heart. Over time, high blood sugars can affect eyes and lead to blindness; cause kidney failure requiring dialysis; and cause nerve damage which results in pain, infections and other foot complications. All these complications impact peoples’ lives significantly.

Q: Tell us how health behaviour choices can help us prevent/manage this condition.

A: Health behaviours and practices play a key role in both preventing and managing diabetes. For those with pre-diabetes or at risk of diabetes, it is possible to dramatically decrease your risk of developing type 2 diabetes through these measures.

For those who live with diabetes, in the early stages it is possible to reverse diabetes or go into “remission” with drastic health behaviour changes. While that won’t be realistic for most people with diabetes, health behaviours remain a cornerstone of treatment. By making these changes, people can keep their hearts healthy and minimize the need for medications and insulin as much as is possible, even if it can’t be avoided entirely.

Q: Where can people learn more about making health behaviour modifications?  

A: There is lots of information about different health behaviour choices out there. It’s important for people to know that not all these recommendations have rigorous studies that support their efficacy and/or safety. One place to find proven health behaviour strategies is on the website of organizations like Diabetes Canada, Hypertension Canada and Heart and Stroke.

There are other newer promising strategies that are emerging, some with more evidence than others: these include ketogenic/low carbohydrate diets, time-restricted eating and intermittent fasting. While these are still relatively new, early evidence is quite promising, so stay tuned.

Q: Tell us about your research. What are your goals?

A: My research team, and several others, have shown that risk of diabetes and diabetes complications is disproportionately borne by people who face various forms of social disadvantage, like poverty, incarceration and food insecurity. My research is focused on understanding why this is the case and testing new solutions to help try to improve care and outcomes for these populations.

Q: Why is research in diabetes and pre-diabetes so important?

A: Cardiovascular disease is one of the leading causes of premature mortality in Canada. When people have heart attacks and strokes, it costs lots of money to provide the care that they need in hospital. That affects all of us. That is part of what makes it so important to understand the upstream factors that contribute to cardiovascular risk – like diabetes. If we can invest more in prevention we can certainly benefit as a society by keeping people healthier and out of hospital as much as possible.

Q: Anything else you would want people to know?

A: I think that it’s important for people to know and recognize that the social determinants of health (things like income, housing, and food access) are the most important predictors of diabetes, cardiovascular disease and other diabetes complications. Addressing the social determinants of health is likely to result in improved health outcomes and health system performance much more than investing in hospital-based technologies or models of care.

Learn more about Dr. Campbell’s research at https://www.researchgate.net/profile/David-Campbell-25?ev=hdr_xprf. More details about the team’s ongoing trial to improve access to healthy foods for people with diabetes can be found here: www.foodrxalberta.ca