Winnipeg Free Press - PRINT EDITION
Province facing 'tsunami,' torn between prevention, treatment
It didn't take long for the looming "diabetes storm" to become a political football in Manitoba.
Moments after the president of the Canadian Diabetes Association warned MLAs this February that the province faces a 48 per cent jump in its diabetes rate -- already the highest on the Prairies -- provincial Liberal Leader Dr. Jon Gerrard tore a strip off the NDP government.
"It remains an epidemic that has not been adequately addressed," Gerrard said after listening to Michael Cloutier's "frank warning" on a growing health and economic crisis stemming from the explosion in Type 2 diabetes, which accounts for 90 per cent of diabetes diagnoses.
"We should have had a much more effective and focused approach to addressing this epidemic. After 11 years (of NDP government), it's getting worse, not better."
Not long after, in a column in the First Nations Voice newspaper, Manitoba Conservative Leader Hugh McFadyen charged the NDP should have taken steps to head off the crisis.
"Despite more than a decade in power, Manitoba's tired NDP government has done little to stem the tide of this devastating disease," he wrote.
"If the provincial government continues to ignore the warnings of the Canadian Diabetes Association and other experts, thousands more Manitobans will develop diabetes, and the economic burden of the disease will continue to grow."
Diabetes experts and advocates, however, see the political picture a little differently.
Lori Berard, nurse manager of the Diabetes Research Group at the Health Sciences Centre, said almost everyone was caught flat-footed by the massive surge in Type 2 diabetes, in which the number of Manitobans with diabetes is expected to rise to 139,000 cases (10.1 per cent of the population) by 2020 from the current 94,000 cases (7.6 per cent of the population).
"The tsunami came without anybody anticipating it," Berard said. "The disease has grown exponentially without any warning. The health system is saturated by this unexpected increase in diabetes. We expected it was on the rise but -- boom! -- not at this rate."
"I wouldn't say the system is failing. It's bursting from the standpoint the incidence of the disease is now where we thought it would be in 2030 and it's only 2011."
In his speech to MLAs, Cloutier made a point of praising Manitoba as one of the few provinces with a well-established diabetes strategy.
"Manitoba has stood at the forefront of the country in its proactive approach to addressing the burden of diabetes," Cloutier told the gathering.
But, faced with an epidemic expected to cost the province $639 million a year by the end of the decade, Cloutier said much more needs to be done.
Manitoba's current strategy focuses on primary prevention, but Cloutier said the time has come for the province to shift its focus toward support for Manitobans already diagnosed with diabetes.
That shift will pay huge dividends down the road, he said, because the staggering costs associated with diabetes stem from its horrific complications, not the disease itself.
"Eighty per cent of the costs are about treatment of downstream complications -- the heart attacks, strokes, kidney failures, amputation, the blindness," Cloutier said later in an interview from Toronto.
"There is good news in this story. There are good treatments available and by treating diabetes, we can significantly reduce the cost to the system by not incurring those downstream complications."
He said the government needs to ensure diabetics have access to the latest medications, devices, supplies, programs and health-care teams, including diabetes educators and endocrinologists.
In Manitoba, diabetics are forced to deal with the highest out-of-pocket expenses in Canada outside the Atlantic provinces, averaging more than $2,500 a year, or 8.4 per cent of their income.
"In fact, our studies have indicated that 57 per cent of all people living with diabetes in Canada cannot afford to comply with their prescribed diabetes management," Cloutier said.
"Health Canada has reviewed and recommended 23 diabetes medications for listing on Canada's provincial formularies. To date, only 10 of these are fully listed for coverage in Manitoba."
The association called on the province to promote goals for healthy weights and offer support programs to help people achieve them, a proposal sources say the government is taking a hard look at.
The generals in Manitoba's war on diabetes, Health Minister Theresa Oswald and Healthy Living Minister Jim Rondeau, agree more needs to be done, but scorned Opposition accusations the government has been twiddling its thumbs as the crisis deepens.
"We've seen the tsunami coming and endeavoured to have a multi-layered approach to dealing with it," Oswald said in an interview. "But even so we're seeing more cases of Type 2 diabetes, and we need to respond to that.
"Anyone who thinks the job is done on diabetes is in very big trouble. We don't think it's time to stop moving our feet. We're trying to push very hard on the prevention side."
But the minister said the government is committed to programs and treatments for people already diagnosed.
"We need to do both," she said. "We can't turn our backs on those who are diagnosed. We have to continue to invest, but we also need to do all we can to stem the tide of new diagnoses. We can never relent on the prevention side."
Among other steps, the province is working to make healthy food more accessible in the North and promoting chronic-disease workshops "to provide continuing education to our health-care providers who are working on the front lines with people who are at risk of getting diabetes or just diagnosed with diabetes."
She also noted Manitoba was one of the first provinces to cover the costs of Lantus, a long-acting insulin that needs to be injected only once a day, and has done a lot of work to bring kidney dialysis closer to people's homes.
"One of the most important things you can say about our administration... we became the first province in our nation to have a department dedicated to healthy living," Oswald said.
The minister of that department, Jim Rondeau, himself a Type 2 diabetic, said a host of new initiatives for stemming the epidemic are coming down the pipe.
"You can always do more, but we've done a huge amount," Rondeau said during one of his daily workouts to keep the complications of his diabetes at bay. "I'll never say we've done enough."
He lashed out at the Tories, noting they proposed doing away with Healthy Living.
"They've said we're ignoring it (the epidemic), but when they want to blow up our department, I don't give it much credibility," he said. "They said they wanted to merge education and healthy living. It would be terrible. My department spends about $70 million on prevention of chronic diseases.
"We're doing a great deal now, but we are going to accelerate with more programs and supports to stem the tide and head off the tsunami."
Republished from the Winnipeg Free Press print edition July 2, 2011 J4
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