Re­search and in­no­va­tion lead­ing to bet­ter out­comes for Cana­di­ans liv­ing with di­a­betes

Ottawa Citizen - - CITY - ABIGAIL CUKIER Postmedia Con­tent Works

In Au­gust 1922, 13-year-old Elizabeth Evans Hughes, ex­tremely weak at only 45 pounds, was one of the first pa­tients treated with in­sulin. It saved her life. She went on to grad­u­ate from col­lege, get mar­ried and have three chil­dren. She died when she was 73.

Be­fore in­sulin, di­a­betes led to death. The best treat­ment was a star­va­tion diet, which al­lowed pa­tients to live a few ex­tra years—if they didn’t die of star­va­tion first. When in­sulin was dis­cov­ered in 1921, it for­ever changed what it meant to have type 1 di­a­betes. To­day, peo­ple with the dis­ease have an al­most nor­mal life ex­pectancy and in­sulin is re­garded as one of the great­est med­i­cal dis­cov­er­ies in his­tory.

But the phar­ma­ceu­ti­cal in­dus­try didn’t stop there. It has con­tin­ued to ad­vance di­a­betes treat­ment. To­day, med­i­ca­tions for type 2 di­a­betes that sup­port car­dio­vas­cu­lar health and weight loss, in ad­di­tion to blood su­gar con­trol, are once again promis­ing to change what it means to be di­ag­nosed with di­a­betes.

In Canada, 3.4 mil­lion peo­ple have di­a­betes. In type 1, the body makes lit­tle or no in­sulin. In type 2, the body pro­duces in­sulin, but can’t use it prop­erly.

Good glycemic con­trol is the hall­mark of di­a­betes ther­a­pies, how­ever ac­cord­ing to Dr. Ron­nie Aron­son, we are now look­ing to ef­fects beyond glu­cose-low­er­ing when se­lect­ing med­i­ca­tion.

“There have been sub­stan­tial changes in the last decade,” says Aron­son, a gen­eral en­docri­nol­o­gist and founder and chief med­i­cal of­fi­cer of LMC Health­care, which has 11 di­a­betes and en­docrinol­ogy clin­ics across Canada. “A move­ment arose for treat­ments that go beyond low­er­ing blood su­gar lev­els to ones that ben­e­fit over­all health and help pa­tients avoid early death.”

Dr. Aron­son says in­no­va­tive new medicines cur­rently be­ing re­searched have been shown to both help with weight loss (of­ten rec­om­mended for pa­tients with type 2) and lower blood pres­sure, while another new class of drugs low­ers blood su­gar, leads to weight loss, and may even re­duce the rate of heart at­tacks, stroke and hos­pi­tal­iza­tion for heart fail­ure.

Th­ese stud­ies are es­pe­cially note­wor­thy as peo­ple with di­a­betes are three times more likely to be hos­pi­tal­ized with car­dio­vas­cu­lar dis­ease, ac­cord­ing to Di­a­betes Canada.

“The old ques­tion for a physi­cian was, ‘How do I lower my pa­tients su­gar?’

Now, the ques­tion is, ‘What drugs should my pa­tient be on to lower their su­gar and op­ti­mize their sur­vival?’” Dr. Aron­son says.

“Pa­tients used to be on 11 pills. We can now re­duce that to five or six and have bet­ter con­trol and weight loss. This is be­cause of the phar­ma­ceu­ti­cal in­dus­try— and it makes get­ting healthy eas­ier.”

Re­search is also chang­ing how peo­ple with di­a­betes mon­i­tor their blood su­gar. Tra­di­tion­ally, they’d prick their fin­gers sev­eral times a day, but to­day, a tiny sen­sor un­der­neath the skin can trans­mit a read­ing every five min­utes to a smart­phone, show­ing how the body re­sponds to in­sulin, food or ex­er­cise. This con­stant aware­ness can help pa­tients avoid high or low blood su­gar or al­low for in­ter­ven­tion be­fore a sit­u­a­tion be­comes se­vere.

How­ever, lack of pub­lic fund­ing and dif­fer­ences in pri­vate cov­er­age means ac­cess to this tech­nol­ogy is out of reach for many. This is the case for many di­a­betes med­i­ca­tions, sup­plies and de­vices, where govern­ment cov­er­age varies across ju­ris­dic­tions.

“Ac­cess is of­ten lim­ited to pay­ing out of pocket or to peo­ple with em­ployee ben­e­fits that cover it,” says Dr. Aron­son. “Th­ese drugs may be more ex­pen­sive, but they save lives, im­prove pro­duc­tiv­ity and re­duce health care costs. Govern­ments should fac­tor th­ese ben­e­fits into their rel­a­tive cost plan­ning.”

Di­a­betes Canada es­ti­mates that di­a­betes costs the health care sys­tem $3.4 bil­lion a year, a num­ber that’s ex­pected to rise to $5 bil­lion by 2026.

“The older, more af­ford­able drugs carry the risks of weight gain and un­wanted low blood su­gar (hy­po­glycemia), which both trans­late to high costs in hospi­tal emer­gency rooms,” says Dr. Aron­son. “Those high costs could be re­duced sig­nif­i­cantly with a move­ment to new types of ther­apy.”

GETTY IM­AGES

In­no­va­tive new medicines are pro­vid­ing the mil­lions of Cana­di­ans with di­a­betes a much-im­proved lease on life.

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