Is B.C. prepared for the diabetes explosion?

NDP MLA Adrian Dix, who has Type 1 diabetes, told the Georgia Straight that some health authorities, including Vancouver Coastal Health, have done a "reasonably good job" addressing diabetes. However, he added that he doesn't think those authorities have made sufficient plans for the coming onslaught of Type 2 diabetes in B.C.

"We're talking about adding probably 100,000 cases within 10 years," Dix said. "Just like you have to prepare for the Fraser River overflowing its banks, the health-care system has to invest in primary health-care service now."

According to the Canadian Diabetes Association, more than two million Canadians have diabetes, with the number expected to rise to three million by the end of the decade. Of those, approximately 10 percent have Type 1 diabetes, in which the immune system wipes out insulin-producing cells. The remaining 90 percent have Type 2 diabetes, in which there isn't enough insulin to absorb blood sugar or the insulin that's produced isn't used properly.

Dr. Bruce Verchere, director of the diabetes research program at BC Children's Hospital, told the Straight that Type 2 diabetes is often associated with obesity. "That used to be a disease of adult onset, but now we see it in kids," he said.

High blood-sugar levels caused by diabetes can lead to very serious complications, such as cardiovascular disease, blindness, kidney failure, and lower-limb amputations.

The former deputy minister of health, Dr. Penny Ballem, said in a videotaped speech in Toronto last December that only 40 percent of people with diabetes are receiving good care in this province. Health Minister George Abbott told the Straight that Ballem's comment may have been true at the time but that there has been significant improvement since then.

"There were provisions contained in the new BCMA [British Columbia Medical Association] agreement that provides financial incentives for ensuring that physicians provide best practices to their diabetes patients," Abbott said.

Under the province's agreement with the BCMA, doctors receive an annual payment of $125 for each patient with diabetes whose management is consistent with clinical-practice guidelines. As well, general practitioners were eligible for a one-time bonus of $7,500 if, as of June 30, 2006, they were caring for at least 10 patients with diabetes or congestive heart failure in the preceding 12 months.

Ballem's comments on diabetes care prompted a fiery editorial in the BC Medical Journal from Dr. Susan E. Haigh, a North Vancouver endocrinologist. She described Ballem's comments as "a great disservice to individuals with diabetes and heart disease and to the doctors who are caring for them".

The B.C. Ministry of Health sent a statement to the Straight noting that health authorities currently fund 80 diabetes-education centres across B.C. Abbott said that the provincial government's ActNow BC initiative is educating people about the importance of healthy body weight, healthy lifestyles, and the importance of exercise. "There's lots of work to be done," Abbott said. "I don't disagree with that at all, but we are taking appropriate steps."

Dix, the NDP health critic, claimed that the Interior Health Authority has cut a diabetes centre in Kelowna. The Interior Health Authority didn't provide a spokesperson to respond to the claim. Dix also claimed that the Fraser Health Authority has failed to prepare adequately for what he called a coming "explosion" of diabetes in the South Asian community.

"Do we want to deal with it in primary health care or do we want to deal with it in emergency rooms?" Dix asked. "Under the present circumstances, we're going to be dealing more and more with the consequences of diabetes in emergency rooms."

Dix said that he worries about the effect of diabetes on the poor, who are less capable of managing their illness. "There are a whole bunch of medical issues involved in the debate about diabetes, but I think that some of the most important are socioeconomic," he said. "The number one concern around diabetes for me is the growing inequality in our city and in our province."

Colleen Fuller, a founder of the Society for Diabetic Rights, told the Straight that governments subsidize the production of soy, corn, and wheat, which results in products with these ingredients costing less in grocery stores. "As a consequence, we have this horrible problem now with poorer people who rely on these kinds of foods because the makeup of the food–the high corn-syrup content and so on–is contributing to the increase in diabetes," she said. "They trigger diabetes. People don't know this. The government should be subsidizing fruit and vegetables in the marketplace so that people can eat better food."

In addition, Fuller said that there need to be many more community-based education programs, which are independent of the pharmaceutical companies' influence. "People have to have the best information about drugs," Fuller said. "Diabetes is a walking industry. It's targeted by everybody: people who make the drugs; people who are selling insulin pumps and glucose-home-monitoring devices; people who are pushing test strips."

According to the Canadian Diabetes Association, aboriginal people are three to five times more likely than the general population to develop Type 2 diabetes.

The Aboriginal Diabetes Awareness, Prevention and Teaching program is run through the Vancouver Native Health Society. "They do community kitchens, and they teach people how to prepare foods if they're diabetic," VNHS executive director Lou Demerais told the Straight. "They also get involved with other groups, like schools and so on, and teach people about healthy eating so they will, hopefully, avoid diabetes."

The CDA states that more than 75 percent of new Canadians, including those of Hispanic, Asian, South Asian, and African descent, have a higher risk than the general Canadian population for Type 2 diabetes.

Diabetes educator German Blanco, who worked for 22 years as a general practitioner in Colombia, meets twice a month with two groups of people in the local Latin American community–some who have been recently diagnosed and others who've been in the program for three years. "Of course, at the beginning, people think, 'Oh my God, it's a problem. I can't eat what I want to eat,'" he said.

Blanco, who works at the Reach Community Health Centre on Commercial Drive, also said that some Latin Americans can't communicate very well with family doctors. "They say that the doctors don't have the time to explain what is diabetes, what are the complications," he said.

Patricia Dabiri, director of Reach's Multicultural Family Centre, told the Straight that the diabetes-education program is also offered to people of African and Vietnamese descent. It was started about seven years ago.

"The Vietnamese [group] meets at Britannia for line dancing and tai chi for the physical component," Dabiri said. "Line dancing is culturally appropriate for the Vietnamese. It's very big in this community. Then they meet here for their community kitchen and health-education component of the program."

She noted that she knows people who've repeatedly asked without success to be tested because they know they are in a high-risk group. "Physicians aren't recognizing that these groups are high risk. It's not commonly known."

Dabiri noted that the diabetes education program at St. Paul's hospital is offered in Cantonese but not in any other languages. Fuller, who has Type 1 diabetes, described the St. Paul's program as "excellent", but said that cutbacks mean that people in nutritional counselling must now pay for their meals.