The incidence of diabetes is increasing among Canadians at an alarming rate. Indeed, the rate of increase technically qualifies as an epidemic. The reasons for this increase are multiple, and indeed some of the factors at play are probably unknown. Known factors include the increasing average age of the population, as the incidence of diabetes increases with increasing age. Another major factor is increased food intake and the increase in the type of food intake. It is very likely that fast foods prepared in deep fried fat are a significant contributor, as is the ready availability of high caloric foods. But perhaps the most significant contributor is the reduction in the amount of exercise done daily by the average person.
It may be wishful thinking to say that we can solve this problem by promoting a healthy lifestyle. Most people would like to stay on a healthy diet for life, and do at least 30 minutes of physical activity daily, but all too often we do not persist with such changes, and we revert at least in part to our former ways.
So we must face the problem by trying to identify solutions in the form of therapy. Are there medicines that will reduce appetite successfully? Are there medicines that, if given very early at the onset of elevated blood sugar, can prevent the development of the disease? Are there treatments that, when given to patients avoid or delay the need for insulin? Are there new types of insulin that can reduce the basic cause of adult onset, type II diabetes, namely a resistance to insulin action? Are there new medicines that can be taken by mouth that will lower blood sugar levels and control blood sugars more effectively? The answer to all of these questions is “yes”.
At the present time, there are two classes of pills for reducing blood sugar levels that are approved in British Columbia for reimbursement under the Medicare system without recourse to “special authority”(meaning the physician has to justify the use of the medicine). These two classes are the Sulfonylureas (glyburide) and the biguanide class, represented by metformin. Yet others in North America can use gliclazide, glimiperide, repaglinide, rosiglitazone, pioglitazone, and miglitol, as well as the newer insulins Humalog and Glargine. These are not available in British Columbian. Should they all be made available? The answer is not simple. Some of these drugs are extremely expensive, and the health care system is trying to guard their finances to allow treatment of multiple diseases. There is no question that, if these medicines represented an essential advance, they might be approved. But who is to make the decision that a new drug is an essential advance rather than a marginal improvement on an existing drug? Rather than giving physicians information on the efficacy and cost of these drugs and allowing them to make these decisions, the government has decided to appoint an advisory body of experts to advise them, none of whom are endocrinologists or who treat people with diabetes. Even after receiving the decision of these non-experts, the government reserves the right to deny the medication if its financial review indicates it will cost too much. Is it correct to do this? Does the epidemic of diabetes cry for a more humane approach? This question has been posed in a poll of British Columbians.
In April 2000, a professional team assessed the public’s reaction to this problem by polling 503 randomly selected adults throughout British Columbia. The results of this poll would be accurate 19 times out of 20 and would differ by no more than 4.4 percentage points. What were the questions asked, and what were the responses? Perhaps you might read each question and answer for yourselves before seeing the responses given.
The questions were:
1. As far as you know, is the incidence of diabetes in BC increasing, staying about the same, or decreasing? If increasing, would you say is rapidly increasing or increasing at a moderate rate?
|Increasing at a moderate rate||36%|
|Staying about the same||17%|
|Increasing but not known at what rate||4%|
2. In your view, should health care spending on diabetes be increased, decreased, or kept at about the same level?
|Kept at the same level||31%|
3. Over the next fifteen years, the incidence of diabetes is expected to nearly double to the point where one person in twelve will have or develop diabetes in their lifetime. This rate of increase qualifies diabetes as an epidemic. Given this, please tell me whether you think spending should increase, decrease or be kept the same for each of the following:
|Increase||Decrease||Kept the Same||Don’t know/refuse|
|a) Public Education about the disease||75%||1%||21%||3%|
|b) Early testing and diagnosis of the disease||79%||1%||14%||7%|
|c) Helping people change their lifestyles to manage the disease||70%||1%||23%||3%|
|d) Research into finding new treatments or cure||83%||1%||13%||4%|
|Best source||Top two sources|
|The Canadian Diabetes Association||60%||40%|
|The B.C. Ministry of Health||12%||30%|
|Your local health region||11%||24%|
|The pharmaceutical industry||4%||12%|
|All of these||3%||4%|
The diabetes epidemic is becoming one of the most costly to the health care system. One fact recently noted was that the cost of all medicines, physician’s costs, and other treatments for people with diabetes are much smaller than just the costs of the treatment of the heart disease that ensues as a result of diabetes. If we had the tools to fight the disease in its early stages, we would reduce these costs very effectively. The current policy of the Ministry of Health appears to be shortsighted. Perhaps you could write to your MLA on this matter?
Dr. Dawson is a director of the BC Endocrine Research Foundation and has been involved with the Canadian Diabetes Association for many years. He is a leader in educating general physicians about diabetes and last year received two of Canada’s most prestigious medical citations. The first was the Gerald S. Wong Award earned for his exceptional efforts in assisting individuals with diabetes. The second was the Distinguished Service Award. He was chosen by his peers to receive this award for his contributions to the field of endocrinology.