As we mark Diabetes Awareness Month in November, it is perhaps good to start with a reality check. The fact is that too many Canadians are already very aware of diabetes, either because they are living with it, or know at least one friend or family member who is.
The latest Statistics Canada data (from 2016) show that about 2.1 million Canadians have been diagnosed with diabetes (7% of the population 12 and older). The overwhelming majority (about 90%), suffer from type 2 diabetes.
Even more alarming is a 2011 report from Diabetes Canada, which looks at skyrocketing increases in the number of Canadians living with diabetes since the year 2000, and estimates that by 2020, one in three Canadians will be affected. (Note that this figure includes people with undiagnosed diabetes and prediabetes.)
Although treatable, diabetes is by no means curable, and it can lead to very serious consequences, including blindness, amputation, kidney failure, heart attack and stroke. For diabetes patients, preventing these outcomes in the long term means carefully controlling their blood sugar levels every day.
The good news is that there are very effective medications to treat diabetes, and new and better treatments are becoming available seemingly every day. Some of the newer drugs produce fewer side effects (low blood glucose, weight gain), and may even reduce the risk of heart attack and stroke for diabetes patients, which would be a major benefit.
Today, thanks to these advancements, along with a healthy diet and exercise, there is no reason why someone with diabetes can’t live a long and active life. And that brings us to the problem: Although experts agree that taking medication consistently is essential to how well we live with diabetes, many patients just do not take their medication as prescribed.
A doctor can diagnose you and they can prescribe medication, but they can’t make you take it. An Express Scripts study in the U.S. found that overall, only 63% of adults are “adherent” with their oral diabetes medications, meaning they take them as prescribed.
Of course, there are different degrees of what they call “non-adherence” with a prescription. It can mean that you don’t take your pills at all, it can mean that you missed one pill, or anything in between. But the fact is that doses and medication schedules are important, especially with diabetes, because every time your blood sugar spikes, it can cause permanent damage to your eyes, kidneys, heart etc. So even if you take the right number of pills, but take them at the wrong times, or forget a dose and try to catch up later, your health could be compromised.
The same Express Scripts (U.S.) study showed that diabetes patients that were adherent to their medications saw the benefits in terms of fewer trips to the emergency room with complications, fewer hospital visits in general, and lower overall spending on their healthcare.
Most diabetes patients cannot control their condition with pills alone. Diet and exercise are critical to maintaining healthy blood sugar levels. Many patients also need to monitor their blood sugar levels and use insulin injections to keep them in a safe range. Add to that the fact that diabetes is often associated with other conditions like high blood pressure and high cholesterol, and it becomes clear that living a healthy life with diabetes is not as simple as “popping a pill”. That said, if pills are prescribed, it’s essential to take them as directed.
Express Scripts Canada processes health benefit claims for millions of Canadians. As such, we have considerable insight into how to improve health outcomes for people living with diabetes, while controlling costs. We use this knowledge to develop solutions that help increase adherence in a number of ways.
For example, members of the Express Scripts Canada Pharmacy can get email reminders when their prescriptions are set to run out, or even set up auto-refills on their account, so they never run out. When there are no refills left, we can even reach out to your doctor to ask for a new prescription. Generally, we know that these features lead to adherence rates that are significantly higher than average.
Of course, research is ongoing into new and better ways to prevent, manage, and eventually, cure diabetes. In the meantime, it is incumbent on diabetes patients to take the lead in safeguarding their own health. No doctor can make you take your pills. No pharmacist can force you to exercise. Though living healthy with diabetes is not easy, it is possible. But in the end, it is all up to you.