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  • McMaster Diabetes Association (MDA)

Access to Diabetes Care: A Pharmacist’s Perspective


World Diabetes Day is November 14th and this year’s theme is Access to Diabetes Care. While therapeutic insulin was developed a century ago and has helped millions of lives, access to insulin and other forms of diabetes care remains a challenge for many people around the world.


Access to Diabetes Care

Why should we care about access to diabetes care?

Key global findings for 2021

Data from the IDF Diabetes Atlas 10th edition (1) shows that the prevalence of diabetes is increasing worldwide:

  • One in ten adults worldwide are living with diabetes

  • Over 81% reside in low- and middle- income countries

  • Almost half are undiagnosed

  • In 2021, diabetes was responsible for one death every five seconds

  • At least $966 billion USD in health expenditure is associated with diabetes

What about diabetes in Canada?
  • One in three Canadians has diabetes or pre-diabetes (2)

  • The prevalence of diabetes (diagnosed) increased an average of 3.3% each year (from 2000 to 2016) (3)

  • People with diabetes account for 40% of all heart attacks and 70% of non-traumatic amputations each year (2)

  • Indigenous communities have an increased burden of diabetes and face more barriers to healthcare access (4,5)


How do inequities in diabetes care access arise?

Challenges to accessible insulin and other forms of diabetes-care supplies arise along the pathway in which the product is manufactured to its distribution to users.


Characteristics of procurement and healthcare delivery systems
  • Over 95% of the global insulin market is dominated by three companies (6)

  • There is a lack of policies on the supply, pricing (including mark-ups in the supply chain), and reimbursement of insulin (6)

Characteristics of vulnerable populations
  • A study investigating the association between the accessibility of healthcare and diabetes status found that diabetes is more likely to go undetected in the uninsured (7)

  • Populations experiencing homelessness experience competing priorities, limited healthcare resources, and limited social support (8)

  • Indigenous communities face barriers to health education systems, negative bias among healthcare professionals, and social exclusion (4)


What strategies can increase access to diabetes care?

We highlight three key areas for improving access to diabetes care.

Strategy

Description

Patient-centered care

The delivery of tailored and culturally appropriate individualized care.

This includes increasing the use of primary care services, adopting services to the needs of patients, improving interprofessional collaboration, and incorporating individuals’ preferences and experiences.(9,10)

Education

The creation of culturally tailored education and the maintenance of knowledge about diabetes.

This includes disseminating information about diabetes and available services on the internet and increasing availability of diabetes self-management education.(4,11)

Advocacy

Actively advocate for individuals with diabetes to promote individual outcomes and influence policy.

This includes lobbying government to influence policies that impact people with diabetes, increasing public awareness about diabetes, and reducing stigma and misconceptions about diabetes.(6)




For this year’s World Diabetes Day, we had a chance to sit down with a Diabetes care – certified pharmacist. Here is what they had to say.


Q: What is the most prevalent concern when it comes to diabetes care for patients?


A: In my experience, I have noticed that patients are usually worried about the cost associated with diabetes care supplies. Supplies such as test strips, lancets, glucometers, and sensors can be quite expensive and are not always covered by insurance. For many patients, the barrier to diabetes care lies in the finances. It can be very overwhelming and tough to purchase such supplies but for patients, it is important to follow up regularly with their physicians and only use supplies when necessary.

Q: Are finances the primary barrier in accessing care for many patients? If so, what can be done to still attain the best care possible?


A: Among others, finances can be a major barrier for many patients. Companies usually offer a lot of promotions on diabetes care products which can help patients save money. Also, for patients in Ontario, test strips, lancets, sensors, and other medications are usually covered by the government. What is surprising is that most patients are unaware of this and end up paying hundreds of dollars out of pocket. Again, this is why it is very important to communicate with your health care team to ensure the best possible care.

Q: In your opinion, what can be done to combat the lack of access to care for patients around the world?

A: With diabetes, it is important for patients to understand that they play an important in managing their condition alongside their pharmacist and physician. Patients must be careful when filling prescriptions and requesting for refills. As always, patients are encouraged to speak to their health care team about any concerns they may have and how care can be tailored towards their needs. All in all, diabetes is a difficult disease but with proper interactions between patients and their healthcare team, it can be easily managed.

Q: This year's World Diabetes Day is focused on Access to Diabetes Care. In celebration of this, how can patients be more informed of their treatment?


A: Many patients I speak to are unaware of the services available and most of these services are free of charge. This is where patient autonomy is very important. Services such as a medication check and patient consultations are very valuable and are available to all patients, diabetes or not, free of charge. I strongly urge patients to take advantage of these services as they can help patients understand why they are taking certain medications and let them know of any alternatives that may be available.

Q: With Diabetes, there are a variety of different products/companies out there. Are there any brands that you recommend?


A: Each brand has its advantages and disadvantages, and it all comes down to patient preference. Brands such as Contour Next, Accucheck, and Freestyle are some of the more popular ones because they are generally prescribed by doctors. Keep in mind that these are also some of the more expensive ones. When purchasing supplies, remember that higher prices do not always amount to higher quality. My recommendation would be to experiment with different products and reach out to your healthcare team for tailored advice.



Written by: Muhammad Ans and Susanna Fang






References
  1. IDF Diabetes Atlas [Internet]. Diabetesatlas.org. Available from: https://diabetesatlas.org/

  2. Diabetes Canada [Internet]. Diabetes.ca. Available from: https://www.diabetes.ca/

  3. Public Health Agency of Canada. Data Blog [Internet]. Canada.ca. Available from: https://health-infobase.canada.ca/datalab/diabetes-blog.html

  4. Nguyen NH, Subhan FB, Williams K, Chan CB. Barriers and mitigating strategies to healthcare access in Indigenous communities of Canada: A narrative review. Healthcare (Basel). 2020;8(2):112.

  5. Shah BR, Cauch-Dudek K, Pigeau L. Diabetes prevalence and care in the Metis population of Ontario, Canada. Diabetes Care. 2011;34(12):2555–6.

  6. Beran D, Lazo-Porras M, Mba CM, Mbanya JC. A global perspective on the issue of access to insulin. Diabetologia. 2021;64(5):954–62.

  7. Zhang X, Geiss LS, Cheng YJ, Beckles GL, Gregg EW, Kahn HS. The missed patient with diabetes: how access to health care affects the detection of diabetes. Diabetes Care. 2008;31(9):1748–53.

  8. White BM, Logan A, Magwood GS. Access to diabetes care for populations experiencing homelessness: An integrated review. Curr Diab Rep. 2016;16(11):112.

  9. Glennie JL, Kovacs Burns K, Oh P. Bringing patient centricity to diabetes medication access in Canada. Clinicoecon Outcomes Res. 2016;8:599–611.

  10. Vachon B, Huynh A-T, Breton M, Quesnel L, Camirand M, Leblanc J, et al. Patients’ expectations and solutions for improving primary diabetes care. Int J Health Care Qual Assur. 2017;30(6):554–67.

  11. Chomko ME, Odegard PS, Evert AB. Enhancing access to diabetes self-management education in primary care. Diabetes Educ. 2016;42(5):635–45.

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