Diabetes Canada borrows B.C. AIDS researcher’s model
Diabetes Canada is adopting a diagnosis-and-treatment model of prevention pioneered by Vancouver-based AIDS researcher Dr. Julio Montaner.
The approach hangs on the notion that modifiable human behaviour helps drive the spread of viruses such as HIV/AIDS and also diseases of lifestyle such as Type 2 diabetes and pre-diabetes.
Montaner notes that people are more likely to become IV drug users if they are raised in a community where injection drug use is normalized and the same applies to smoking or eating fast food, what he calls “social contagion.”
“With disease, there may be a virus or a pathogen that is transmitted, but behind that are behaviours that are amenable to intervention,” he said.
While there is no virus for Type 2 diabetes, risk factors such as obesity, high blood pressure and high cholesterol can be addressed with changes in diet and activity level.
Montaner has touted the diagnosis-and-treatment model for other contagious diseases such as hepatitis C and tuberculosis, but argued successfully that it can be adapted for diabetes.
Diabetes Canada plans a massive expansion in screening among the six million Canadians believed to have prediabetes as a way to ensure that people get treatment and undertake preventive lifestyle changes that would set an example to other family members and entire communities, said Russell Williams, vice-president of Government Relations and Public Policy at Diabetes Canada.
“It’s so complicated that there is no one simple solution,” he said. “We need all levels of government, academia and health care professionals to take a new approach.”
The 90-90-90 Treatment as Prevention model developed at the B.C. Centre for Excellence in HIV/AIDS calls for 90 per cent of people with HIV to be diagnosed, 90 per cent of those on antiretroviral therapy and 90 per cent of those with no detectable virus by 2020. Reaching those goals is expected to reduce the expression of HIV as AIDS and mortality by 90 per cent.
“With HIV/AIDS we had to change the attitude of the system from come and get treatment, if you can, to proactively finding people, promoting harm reduction, facilitating treatment and engaging with people at risk early on,” said Montaner. “By doing that we have stopped the progress of the pandemic.”
Beds and resources dedicated to fighting the HIV/AIDS epidemic have been reallocated to fight other diseases. A similar approach to diabetes could help ensure the sustainability of Canada’s health care system, he said.
The cost of treating diabetes is predicted to increase by 40 per cent — to $5 billion annually — within 10 years, according to Diabetes Canada.
“This is a tsunami and if we don’t grapple with this, it will be very draining on our health care system,” said Williams.
The Diabetes Canada 90-90-90 targets are to screen 90 per cent of prediabetic Canadians, treat 90 per cent of people with prediabetes and diabetes and see 90 per cent of those in treatment achieve measurable improvements in blood glucose levels.
“The first step is identifying people at risk of getting diabetes and then we try to prevent them from ever getting diabetes,” he said. “Diabetes contributes to 30 per cent of strokes, 40 per cent of heart attacks and 50 per cent of kidney failures, so the impact can be huge.”