Type 2 diabetes is a chronic, progressive disease characterized by the body’s resistance to the effect of insulin and, over time, the gradual loss of the pancreas’ ability to produce insulin, according to Dr. Donna Mojdami, a clinical research physician in diabetes at Eli Lilly Canada, speaking during a session at Benefits Canada‘s 2022 Chronic Disease at Work event in February.
About eight per cent of Canadians have diabetes — and 90 per cent of this group has type 2. Between 2004 and 2014, the prevalence of diabetes in Canada increased 37 per cent and will continue to rise as the population grows and ages.
Risk factors include increased age, obesity, physical inactivity and family history. In addition, type 2 diabetes has a high degree of association with other medical conditions such as hypertension, high cholesterol, cardiovascular disease and fatty liver. Microvascular complications, such as diabetic eye disease, can lead to blindness if not controlled appropriately or kidney disease, which can lead to kidney failure and ultimately dialysis, while macrovascular complications can lead to strokes and heart attacks.
Management of type 2 diabetes is complicated, multifaceted and has evolved over the years, said Mojdami. “We’ve really shifted our mindset away from a glucose-centric approach.”
A large part of type 2 diabetes management includes lifestyle intervention, such as physical activity and nutrition therapy, however some patients may also need medications, she added.
Diabetes Canada guidelines are based on the best evidence for the management of patients with type 2 diabetes, with recent updates including a focus on managing related complications in addition to improving glucose levels. Physicians aim to get patients’ blood pressure and cholesterol levels to target and may also prescribe drugs to reduce their risk of heart or kidney disease.
“What’s exciting is that we have a lot of new medications that are providing benefits beyond just glucose control,” said Mojdami, noting older drugs focused only on glucose levels without any real benefits for comorbidities. “Despite all these exciting advances in the last 10 years, we still have treatment gaps in diabetes management.”
Fewer than half of those with type 2 diabetes still aren’t meeting their glycemic control targets, while 90 per cent or more are still struggling with being overweight. Almost half aren’t at their blood pressure or cholesterol targets and fewer than five per cent are on medications that help protect their hearts.
According to Mojdami, the reasons could be due to the lack of integrated care, poor medication adherence or access challenges, while low diabetes awareness may also play a part. Patients may know their blood sugars are high, but they have no idea what that means in terms of complications. Fortunately, she noted, some of the newer therapies not only improve glycemic control, but also have a positive impact on weight, in addition to improving cardiovascular and kidney health.
Mojdami suggested benefits plan sponsors offer accommodations for members with diabetes, as well as access to counselling, if required. They can also promote health and wellness programs or diabetes awareness sessions to all plan members. She also recommended that plan sponsors assess their benefits coverage to ensure members have access to the newest evidence-based diabetes medications and that clinical criteria are aligned with the latest diabetes guidelines.
Read more coverage of the 2022 Chronic Disease at Work conference.