Abstract
Promoting adequate levels of physical activity in the population is important for diabetes prevention. However, the scale needed to achieve tangible population benefits is unclear. We aimed to estimate the public health impact of increases in walking as a means of diabetes prevention and health care cost savings attributable to diabetes. We applied the validated Diabetes Population Risk Tool (DPoRT) to the 2015/16 Canadian Community Health Survey for adults aged 18–64, living in the Greater Toronto and Hamilton area, Ontario, Canada. DPoRT was used to generate three population-level scenarios involving increases in walking among individuals with low physical activity levels, low daily step counts and high dependency on non-active forms of travel, compared to a baseline scenario (no change in walking rates). We estimated number of diabetes cases prevented and health care costs saved in each scenario compared with the baseline. Each of the three scenarios predicted a considerable reduction in diabetes and related health care cost savings. In order of impact, the largest population benefits were predicted from targeting populations with low physical activity levels, low daily step counts, and non active transport use. Population increases of walking by 25 min each week was predicted to prevent up to 10.4 thousand diabetes cases and generate CAD 74.4 million in health care cost savings in 10 years. Diabetes reductions and cost savings were projected to be higher if increases of 150 min of walking per week could be achieved at the population-level (up to 54.3 thousand diabetes cases prevented and CAD 386.9 million in health care cost savings). Policy, programming, and community designs that achieve modest increases in population walking could translate to meaningful reductions in the diabetes burden and cost savings to the health care system.
Highlights
This study demonstrates how the tool can be applied for modeling the impact that changes in baseline risk factors will have on future diabetes incidence
Using Diabetes Population Risk Tool (DPoRT) equations, baseline diabetes risk was determined for all individuals residing in the province, excluding 3262 respondents who were less than 20 years old, 2974 respondents with a prior diagnosis of diabetes, and 3075 respondents with missing risk factor information required for DPoRT
The current study focused on the impact of increases in walking in reducing diabetes risk at the population-level to inform future directions for diabetes prevention
Summary
Direct health spending on diabetes has increased worldwide due to rising numbers of people living with diabetes, and as a result of higher year over year medical spending on people with diabetes [1,2]. In Canada, the number of new cases of type 2 diabetes were projected to increase by 2.16 million between 2011 and 2021, which amounts to an estimated CAD 15.36 billion dollars in health care costs [3]. Sedentary lifestyle and physical inactivity levels are increasing world-wide [4] and are among the most important risk factors for developing diabetes [5]. Global physical activity guidelines recommend that adults accumulate 150 min of moderate- to vigorous-intensity physical activity per week, which includes activities such as walking briskly, bicycling, Int. J.
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