Re: Diabetes in BC

Issue: BCMJ, vol. 61, No. 1, January February 2019, Pages 9,11 Letters
By: John Sehmer, MD

Dr Ur, in his editorial for the November 2018 diabetes theme issue [BCMJ 2018;60:436-438], suggests we are grossly undertreating diabetes in BC, and that British Columbians deserve better.

Epidemiological evidence does not support this assertion. Data from the Canadian Institute of Health Information[1] found that Alberta and BC have the lowest rates of diabetes in Canada. Diabetes Canada also confirmed this incidence rate[2] and even proposed that by 2020, BC, at 25.4%, will have the second lowest prevalence of diabetes and prediabetes in Canada, after Alberta (23.6%) and will remain below the Canadian average (26%).

BC has the lowest rates of obesity, the highest rates of physical activity, and the highest per-capita consumption of fruits and vegetables in Canada. Perhaps we’re already doing well compared to other provinces? Some might wonder, maybe we are not sufficiently screening for diabetes in BC? Not if what Diabetes Canada says is reliable, when they report that among all Canadian provinces, BC has the highest rate of screening for diabetes in Canada.[3] Canada has great variability, across provinces, how many diseases impact the population. In terms of diabetes hospital admissions, Quebec and BC have the lowest rates in the country, below the Canadian and OECD averages.[1]

Dr Ur’s article, “Challenges to managing type 2 diabetes in British Columbia: Discordant guidelines and limited treatment options,” not surprisingly, is highly critical of the Therapeutics Initiative.

Diabetes is a major cause of morbidity in British Columbia, but there are also myriad other health care issues. It is only reasonable that scarce funds are not wasted on very expensive new patented medications when generic ones may suffice. 
—John Sehmer, MD, MSc
Vancouver

This letter was submitted in response to “Guest editorial: Diabetes in British Columbia: Starvation in the midst of plenty” and “Challenges to managing type 2 diabetes in British Columbia: Discordant guidelines and limited treatment options.”

References

1.    Canadian Institute for Health Information. International comparisons: A focus on diabetes. Accessed 11 January 2019. https://secure.cihi.ca/free_products/oecd-diabetes-report-2015_en.pdf.

2.    Canadian Diabetes Association. Diabetes: Canada at the tipping point. Accessed 11 January 2019. www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/canada-at-the-tipping-point-english.pdf.

3.    Canadian Diabetes Association. Diabetes Charter for Canada. Accessed 11 January 2019. www.diabetes.ca/getmedia/5a7070f0-77ad-41ad-9e95-ec1bc56ebf85/2015-report-on-diabetes-driving-change-english.pdf.aspx.

John Sehmer, MD. Re: Diabetes in BC. BCMJ, Vol. 61, No. 1, January, February, 2019, Page(s) 9,11 - Letters.


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