Ontario's Diabetes picture: A comparison to parallel provincial initiatives

In 2013-2014 close to 200,000 Canadians were newly diagnosed with diabetes. Certain risk factors include making healthy lifestyle choices such as eating well, exercising and maintain healthy weight (Ransom, Goldenberg, Mikalachki, Prebtani & Punthakee, 2013). The overall prevalence of diabetes is higher among males than females. The prevalence of diabetes is greatest in aboriginal population than others (Public Health Agency of Canada, 2017).

1.5 Million Ontarians live with Diabetes (as of 2016) (Ministry of Health and Long Term Care (MOHLTC), 2018)

Ontario initiatives to help diabetics improve their quality of life

In my practice, within the Intensive Care Unit, there are many patients (majority) of our patients have Type 2 Diabetes. Primarily prevalent within the population of senior citizens. I’ve also seen many a patients who have Type 2 Diabetes and it is a major comorbidity that has influenced their current critical state. One of the many examples are individuals with Coronary Artery Disease, Ischemia to the limb(s). Diabetes and its nature of disease (i.e.: effect on vasculature) cannot be understated when understanding the disease.

This is evidenced by the fact that diabetics are 3 times more likely to be hospitalized as a result of cardiac disease, 12 times more likely to contract end-stage-renal disease, 20 times more likely to be hospitalized for non-traumatic limb amputation (Diabetes Canada, 2018).

Diabetes contributes 30% of stroke, 40% heart attacks, 50% kidney failure and 70% limb amputation per year.

- Populations such as those of South Asian, Asian, African, Hispanic or Indigenous background. Ontario’s diversity insists that the prevalence of these individuals is high and it does increase the overall prevalence of Diabetes in the province.

- Individuals that are overweight. 47% of Ontario residents are physically inactive, 62% are not eating enough fruits and vegetables, and obesity affects 26% of adults and 12% of youth population

- Diabetes rates are three to five times higher in First Nations populations than in the general population

- Overweight

- Old age

- Low income: Ontario has the highest prevalence of low income families—difficulty in managing the condition due to cost of supplies.

Ontario Drug Benefit plan covers:

· most types of insulin

· oral medications (hypoglycemics)

· blood testing strips (based on diabetes treatment)

Trillium Drug Program covers:

· most types of insulin

· oral medications (hypoglycemics)

· blood testing strips

Financial aid for insulin supplies

The Assistive Devices Program (ADP) covers the following insulin supplies for select senior citizens that require insulin injections (daily). They may receive up to $ 170/year.

(MOHLTC, 2018)

Canadian Diabetes Association Cost Model (DCM)

Canadian Diabetes Association. (2015). Impact of offloading devices on the cost of diabetic foot ulcers in Ontario.

Upon collaboration with a classmate, we found that there were many similarities in Ontario to that of Nova Scotia in regards to their prevalence, population of diabetics and provincial initiatives to improve management for the individuals. This perpetuates the notion that diabetes is a share chronic illness throughout the nation and a plan to mediate the issue is relatively uniform.

Rural populations have higher levels of diabetics than their general population. For the similar reasons to Ontario in which these populations (rural) and first nations individuals have greater level of diabetes due to poor management and access to healthcare settings.

Seniors are of the greatest percentage of population in Canada, and much like Ontario, there is great prevalence o f diabetes amongst this group of people

Lower socioeconomic status is also attributed to greater prevalence of Diabetes.

The community programs in Nova Scotia are present to assist Diabetics with funding for prescription drugs and assistance for funding diabetes supplies (Canadian Diabetes Association, 2016).

Ontario programs

- OHIP+: Automatic full coverage with no up-front costs for those under 25 years old.

- First Nations Health Action Plan: Helps funding and access to services for First Nations people

- The Monitoring of Health Program: Provides funding for supplies. The maximum reimbursement for strips and lancets is $920 per year in September 2016.

(Diabetes Canada, 2018)

Treatment:

The clinical practice guideline recommended by Diabetes Canada (2018) is what has inspired treatment plan for diabetics. In the ICU, fluctuations in diabetes are extremely severe. We have many patients (diabetics) that have Diabetic Ketoacidosis. These patients require ICU, close monitoring, fluid resuscitation and insulin infusions along with correction of electrolytes. We also have patients on the other side of the severe, in which patients become hypoglycemic and have decreased level of consciousness and that can perpetuate hypercapneia and other conditions that can have grave consequences to the patient. ICU nurses should be well versed in being able to recognize symptoms of hypo and hyperglycemia.

Resources

Canadian Diabetes Association. (2015). Impact of offloading devices on the cost of diabetic foot ulcers in Ontario. Retrieved from http://www.diabetes.ca/getmedia/5109456e-8c0b-458f-b949-a5accd41513a/impact-of-offloading-devices-ontario.pdf.aspx

Canadian Diabetes Association. (2016). Diabetes in Nova Scotia. Retrieved from https://www.diabetes.ca/getmedia/ad07ad57-5b9b-4148-8132-44118f0bbe03/diabetes-charter-backgrounder-ns-2016-06.pdf.aspx

Canadian Diabetes Association. (2013). Financial Assistance Programs for People Living with Diabetes, Nova Scotia. Retrieved from https://www.diabetes.ca/CDA/media/documents/diabetes-and-you/know-your-rights/nova-scotia-financial-assistance-programs.pdf

Diabetes Canada. (2018). Diabetes in Ontario. Retrieved from https://www.diabetes.ca/getmedia/c9e06018-41f4-4ee8-a9a7-a8c41c8041c1/2018-Backgrounder-Ontario_AT_AB-edited-13-March-2018.pdf.aspx

Diabetes Canada. (2018). 2018 Clinical practice guidelines: Quick reference guide. Retrieved from http://guidelines.diabetes.ca/docs/CPG-quick-reference-guide-web-EN.pdf#page=2

Ministry of Health and Long Term Care. (2018). Preventing and living with diabetes. Retrieved from https://www.ontario.ca/page/preventing-and-living-diabetes#section-0

Public Health Agency of Canada. (2017). Diabetes in Canada: highlights from the Canadian chronic disease surveillance system. The government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/diabetes-canada-highlights-chronic-disease-surveillance-system.html

Ransom, Goldenberg, Mikalachki, Prebtani & Punthakee. (2013). Reducing the risk of developing diabetes. Canadian Journal of Diabetes. https://doi.org/10.1016/j.jcjd.2017.10.033