Won the Nobel, losing the diabetes battle

Ninety years after Canada’s greatest medical triumph, the disease it appeared to tame has morphed and grown to epidemic proportions.

This fall marks the 90th anniversary of Canada’s first Nobel Prize win, one that honoured the greatest medical research achievement in Canadian history: the discovery of insulin.

Yet less than a century later, the promise of taming diabetes is shattered by an epidemic doctors Frederick Banting and George Best couldn’t have imagined.

Today, almost one in 10 adults over the age of 40 walking past the Banting and Best Institute on Toronto’s College Street have, or soon will develop, diabetes.

Their quality of life will be reduced and their lives shortened by diabetes-related health complications.

How did a great medical discovery morph into a health disaster?

What’s changed is that Banting’s and Best’s research was driven to treat what we now call type 1 diabetes. It’s a childhood-onset autoimmune disease in which insulinproducing pancreatic cells are killed. Banting and Best gave the first insulin injection to a 14-year-old in Toronto.

Today’s epidemic is one almost unknown in Banting and Best’s day: type 2 diabetes. It’s a more complicated lifestyle version of diabetes, one that’s different enough in its fundamental nature from type 1 that it warrants a different name.

Type 2 diabetes is caused by being overweight, a poor diet and inactivity. As a result, the body is so poisoned that cells lose their ability to use insulin, and in some cases the pancreas also loses the ability to produce it.

Individuals have a greater or lesser susceptibility based on genetic makeup, but it’s the other factors that trigger type 2’s onset.

In 2008-2009, 3,287 Canadian teens and children were diagnosed with diabetes, largely type 1. In that same year, almost 83,640 middleaged Canadians aged 40 to 60 learned they had type 2.

If current incidence trends continue, the Public Health Agency of Canada estimates that in 2018 a staggering 3.8 million Canadians will be living with diabetes. That’s the equivalent of the entire current populations of Ottawa, Calgary, Quebec City and Saskatoon combined. More than 95 per cent of these cases will be type 2.

Yet Canada’s public health agencies aren’t making a clear distinction between these two very different diseases. For example, the Public Health Agency of Canada’s Diabetes in Canada, 2011 report lumps types 1 and 2 together in its statistics.

They are fundamentally different in their origins, and how we approach treating them should also be.

With type 2 diabetes we need to avoid taking a primarily biomedical approach to treating a psychosocial challenge. Researchers are currently beavering away to understand the biochemistry at play as our cells are slowly smothered by excesses of fat and sugar.

Yet we already have successful treatments for type 2 diabetes: Weight loss. Exercise. Change of diet.

The Canadian Diabetes Association estimates that more than half of all cases of type 2 diabetes in Canada could be delayed, or prevented, through changes in diet and exercise.

Banting and Best succeeded in isolating insulin, but it’s another huge challenge to isolate ways to change our behaviours.

Unfortunately, there’s no Nobel Prize for public health initiatives. There should be. While advances in understanding biochemistry are critical, most of the health gains in the 20th century were won in the water treatment plants, sinks and family doctors’ offices. Community water chlorination, hand-washing and immunization have saved more lives than more medically glamorous heart transplants or biomedical advances.

With type 2 diabetes we face a big public health challenge.

A symbolic case in point: For some men with type 2 diabetes, the only thing that eventually brings them to exercise and a change in diet is losing the ability to get an erection. They endure the loss of toes, feet and eyesight. But when Mr. Johnson’s threatened, something has to change.

On a societal level, Mr. Johnson is threatened. Our collective virility is wilting under the health-care costs and personal damage of this now largely self-inflicted disease.

The economic burden of type 2 diabetes for Canadians topped $12 billion in 2010, what the Canadian Diabetes Association warns is an “economic tsunami.”

It’s a situation that warrants Nobel-level rethinking of how we help those with type 2 diabetes. In many cases a year-long gym membership (and even add a personal trainer) costs less than a month or two of medication for type 2 diabetics.

Canada’s governments and public health agencies need to speak with one voice when it comes to type 2 diabetes: we know the straightest path to better health, and for most Canadians it isn’t through biomedical research labs, but starts with our breakfast bowls and the sneakers by the door.