By: Ehud Ur, MBBS, FRCPC
Re: Diabetes in BC. Author replies
Issue: BCMJ,
vol. 61, No. 1, January February 2019,
Pages 11-12 Letters
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
Vancouver
This letter was submitted in response to “Re: Diabetes in BC.”
References
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.
2. O’Brien J, Karam S, Wallia A, et al. Association of second-line antidiabetic medications with cardiovascular events among insured adults with type 2 diabetes. JAMA Netw Open 2018;1:e186125.
