In his letter, Dr Sehmer disputes our assertions regarding the limited treatment options for diabetes in BC, yet he cites epidemiological data on incidence rates, obesity, and physical activity, none of which are relevant to our argument, and none of which we dispute.
British Columbia is indeed fortunate to have a somewhat lower (though still alarming) incidence of diabetes, and complex social, economic, and demographic factors are at play here. The problem is what happens to British Columbians after they are diagnosed with diabetes, and it is simply a matter of public record that therapeutic options for diabetes in our province are limited in comparison to the rest of the country. Of course, even in BC, they are not limited for fortunate individuals like government and university employees who have extended employment insurance benefits that provide them with access to modern evidence-based medications that other provinces offer to their less-wealthy residents.
Those who are excluded in BC are the poor and the old, and I do not believe that offering them additional therapeutic options would constitute wasting scarce funds.
Multiple recent trials have demonstrated outcome benefits (CVD, total mortality) for these newer, more expensive medications. Benefits that have never been demonstrated for older cheaper drugs (as concerns for their harms grow).[1,2]
—Ehud Ur, MBBS, FRCPC
This letter was submitted in response to “Re: Diabetes in BC.”
1. Ismail-Beigi F, Moghissi E, Kosiborod M, Inzucchi SE. Shifting paradigms in the medical management of type 2 diabetes: Reflections on recent cardiovascular outcome trials. J Gen Intern Med 2017;32:1044-1051.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org