There is More to Diabetes… Innovation in Diabetes Care

Woman with type 1 diabetes, using a continuous glucose monitor to read her blood sugar level

Did you miss the November 24th, 2022, Benefits Breakfast Club (BBC) session on diabetes? Whether you were there or not here is an overview and some key takeaways!

As rates of diabetes continue to rise, plan sponsors and their plan members should be aware of the critical role of healthcare practitioners and the new innovations in monitoring, screening, and treatment. Primary care physicians, optometrists, and pharmacists, all have unique expertise to bring to patient care. Not only can they assist in the early diagnosis and management of diabetes, but also in the prevention and treatment of co-morbidities, which can be life threatening if untreated. At this BBC session we explored the innovative tools and services that are available to patients.

Attendees told us that their top takeaways included:

  1. Importance of early detection
  2. The ongoing evolution of diabetes care
  3. The added value of glucose monitoring in diabetes management
  4. The value optometrists can bring to patient care and the need to fill gaps in current vision care benefits in managing diabetes
  5. The pharmacist’s role in patient education and managing diabetes
  6. Innovations in monitoring, management, and the treatment of diabetes.

Managing Blood Glucose

Dr. Gihane Zarifa, a family physician at the Credit Valley Family Health Team in Mississauga, Ontario addressed the changes in glucose monitoring technology, its impact, and why change was necessary.

Diabetes and its complications is an issue of growing concern to plan sponsors. Canada has the third highest prevalence of diabetes among individuals aged 20-79 when compared to Europe, North America, and Oceania (2010). In 2023 the direct costs of diabetes are projected to reach $32 billion. When diabetes is uncontrolled, complications can occur that drive health-related costs even further. Health complications include strokes, blindness, heart attacks, kidney failure, and amputations. The associated costs in terms of absence from work are two-fold higher for people with diabetes-related complications. Just a 1% reduction in A1C is associated with significant reductions in the risk of many co-morbidities.  

There is more. According to Dr. Zarifa, an A1C result is not the whole story when managing diabetes. New glucose monitoring solutions can help the patient and healthcare provider identify highs and lows in blood glucose, provide alerts and time in range monitoring, daily patterns, immediate feedback, and estimated A1C. Immediate feedback, knowledge, and understanding leads to change in behaviours that improve management and can reduce complications.

Preventing and Managing Diabetic Retinopathy

Most people are aware that complications of diabetes can occur, but do not know specifics. Dr. Joshua Smith, Optometrist and Past President of the Ontario Association of Optometrists, provided insights into eye care and eye disease for those with diabetes, particularly the cost of diabetic retinopathy, and current gaps and inconsistencies in vision care coverage that result in barriers to appropriate care.

The most common eye complication of diabetes that is not well controlled is diabetic retinopathy, which is a disease of the small blood vessels. These small vessels can leak, with hemorrhages that are visible on the retina surface. For some, new blood vessel growth can have a catastrophic effect on vision.

Diabetic retinopathy is the leading cause of legal blindness in adults of working age and impacts a surprising 50% of those with diabetes after 10 years, and close to 100% after 20 years. When vision is impacted there can be a significant impact in the workplace, particularly for those in safety sensitive positions.

To monitor for diabetic retinopathy, those with diabetes require more frequent optometrist’s visits and regular imaging. Imaging is not usually reimbursed by group vision care plans or by provincial health plans. This gap in care means some patients with diabetes do not receive the necessary imaging to monitor the progression of their disease, and the opportunity for early intervention. This leads to poorer outcomes for patients with diabetes and higher costs for plan sponsors in the longer term.

Pharmacy and Drug Innovation

Frances Chung, Staff Pharmacist with Sobeys National Pharmacy Group provided insights into the services and support pharmacists can offer. These can be personalized care plans for those with diabetes, one-on-one consultations, or an insulin start program. In addition to traditional medication reviews, pharmacists now deliver a host of other services including nutrition counselling, cross-care support, diabetes technology advice, A1C testing at nominal cost, support for insulin use and injections, telemedicine, and virtual care, plus technology to improve compliance through a scanning app/physical scanner that are prescription drug label readers.

Looking into the future there are emerging solutions that give hope for improved management of diabetes. These include new drug treatments that could delay the onset of type 1 diabetes, optimize glucose levels, and lower body weight. Technology developments will optimize insulin delivery and glucose monitoring. There are also new developments in the regeneration of insulin in pancreatic stem cells.

Connecting Deliverables with Patients

Collaborations can deliver more value to patients. Dr. Smith and Ms. Chung emphasized their interest in working with plan sponsors to deliver meaningful education to their employee population about diabetes and management of the disease.

We will be offering a recording of this fascinating webinar on innovation in diabetes care in the New Year. We will also be recording a podcast with Dr. Smith in January 2023 that will take a deeper dive into the role of optometrists in the identification and management of diabetes and diabetic retinopathy.

Thank you once again to our presenters and the positive feedback we received from attendees.

Also, thank you all to our season sponsors. We look forward to seeing you on February 9th at our next BBC webinar on The Changing Risk Landscape. You can find out more and register here.