Awareness, access key to managing and preventing complications

By Lori Bamber, Managing Editor

Amber Mitchell was diagnosed with type 1 diabetes at the age of 12, and for many years she was the only person in her school with the disease. Diabetes was still uncommon in the small Manitoba town in which she was raised, and she estimates that there weren’t more than a handful of people with diabetes in the entire region.

“It can be very isolating,” she says. “There is so much stigma and judgment out there – people don’t really understand what it’s like.” While it is tough for every child to make the transition into adulthood, Ms. Mitchell says it was a lot harder being surrounded by well-meaning but uninformed people who said things like, “You shouldn’t be eating that!” when they saw her sharing a treat with a friend. “It just made me feel really alone,” says Ms. Mitchell.

As a result, she rebelled and didn’t take great care of herself, she says, until she had a wakeup call at age 24 after a small scrape on her foot became infected during a whitewater rafting trip. With the nerve and circulatory complications of diabetes, exposing her feet to icy water left her with a dangerous infection that her doctor warned could lead to septicemia – a serious, life-threatening infection – and even a foot amputation without proper care.

Today, Ms. Mitchell is far from alone: the Canadian Diabetes Association (CDA) estimates more than nine million Canadians live with diabetes (type 1 and type 2 diabetes) or prediabetes. But while the disease has reached epidemic proportions, the lack of awareness and understanding Ms. Mitchell experienced growing up continues to be a significant challenge.

Both type 1 diabetes (an autoimmune disease often, but not always, diagnosed in childhood) and type 2 diabetes (a disease that is usually, but not always, diagnosed in adulthood and is influenced by genetic, environmental and lifestyle factors) are serious diseases. But because people die from the complications of the disease rather than the disease itself, it isn’t taken as seriously as it should be, says Dr. Jan Hux, chief science officer at the CDA.
“Canadians need to know that diabetes is serious, it’s important, and it’s manageable,” she stresses.

“It is a leading cause of heart attack, but when somebody has a heart attack they don’t think of it as having a diabetes attack, even though it is a direct consequence of their diabetes. When their kidneys fail because of diabetes – they’re having kidney failure,” Dr. Hux explains.
At the same time, she says, “diabetes is manageable. The treatments available now have dramatically improved the outlook for people with diabetes, in respect to their risk of complications.”

A study published in 2013 in The New England Journal of Medicine showed that for people with diabetes, the risk of having a heart attack fell by two-thirds between 1990 and 2010. During the same period, the risk of stroke and amputation fell by half, and the risk of kidney failure by almost a third. Decades of research have resulted in “better and better treatments leading to better outcomes,” says Dr. Hux.

The risk of complications could be reduced much further if all Canadians had equal access to the medications and care supplies they require. “Medication, taken regularly and appropriately, is a cornerstone of treating this disease,” she notes.

A survey conducted by the CDA found that 57 per cent of people with diabetes report that they can’t afford their prescribed treatment due to a high out-of-pocket cost. Depending on where they live and what supports they use (medications, devices such as insulin pumps, etc.), individuals with diabetes can pay anywhere from zero up to almost $7,000 per year out of their pocket. Almost all Canadians live with catastrophic drug costs, defined as over three per cent of their average annual income, or more than $1,500. These costs are especially prohibitive for low-income Canadians.

“Essential resources are not equally available to all Canadians,” says Dr. Hux. “In particular, a vulnerable group that is of great concern to us are those people who are not covered by either private or public drug benefit coverage.”

For people over 65, those who are disabled or unemployed and qualify for social assistance, and those who are employed by a company that provides a drug benefit plan, drug and care supply costs are covered to some degree. But for the many who fall between the cracks, the medication and support that enables them to manage their disease is simply out of reach.

“It’s penny-wise and pound-foolish,” says Dr. Hux. “The downstream consequences are the increased burden of complications – and those complications account for about 80 per cent of the costs associated with the disease.”


Did you know?

If you have any signs or symptoms of diabetes, you should contact your health-care provider right away and get yourself checked. “Getting your blood glucose checked gives you a benchmark, so you can take steps to either reduce your risk or manage your diabetes,” says Dr. Jan Hux, chief science officer of the Canadian Diabetes Association.

To learn more about diabetes, visit www.diabetes.ca or call 1-800-BANTING (226-8464).  


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