Amid an increase in diabetes diagnoses among Canadians, pharmacists can play a greater role in employers’ and private payers’ chronic disease prevention and management strategies given their increasing scope of practice, said representatives for Health Solutions by Shoppers, during a webinar hosted by Benefits Canada and sponsored by Health Solutions by Shoppers in January.
As Canadians face longer wait times to access the public health-care system, working with pharmacists can help to speed up diagnoses and slow the condition’s progression.
“If we’re not identifying people who have diabetes and managing them appropriately in the earlier stages or in the pre-diabetes stage, unfortunately the cost of managing them increases, [as do] the comorbidities, alongside the progression of [the disease],” said Lori LeBlanc, Health Solutions’ vice-president of pharmacy services and strategic initiatives.
Almost 12 million Canadians have either type 1, type 2 or are considered pre-diabetic. According to Express Scripts Canada’s 2023 drug trend report, the number of diabetes claimants across all age groups have been steadily rising since 2018.
Also speaking during the webinar, Lesley McCullough, senior director of business development at Health Solutions, noted while genetics play a role, industrialization and its related reduction in physical activity, as well as easier access to higher-caloric and ultra-processed foods, have also shaped Canadians’ collective susceptibility to type 2 diabetes. With factors such as convenience, affordability, cravings and even mood influencing what people eat, “it can feel like an uphill battle to eat for optimal nutrition and health.”
Metformin is the most common treatment for diabetes and while it’s fairly inexpensive, it isn’t effective at reducing glucose levels for all patients, said Dr. Jennifer Poh, senior director of drug plan solutions at Health Solutions. Thanks to advancements in research and development, a host of second-line glucose-lowering medications have come onto the market in the last 20 years, including DPP-4, GLP-1 and SGLG-2 inhibitors such as Tragenta, Jardiance and Ozempic.
While they’ve proven effective, those treatments have also increased costs for patients and plan sponsors, said Dr. Poh. Semaglutide drugs, including Ozempic, were the top drug by spend for plan sponsors in both 2021 and 2022 and the spend per diabetes claimant has increased 35 per cent in the past five years, according to Express Scripts Canada’s report.
McCullough and LeBlanc encouraged employers and insurers to focus on addressing diabetes with a combination of preventative solutions and those that delay disease progression, and to include pharmacists as part of those strategies.
In many provinces, pharmacists are allowed to provide clinical care to patients, LeBlanc said. “We know that behaviour and lifestyle changes are extremely important and so it allows our pharmacists to have those regular touch points so patients are committed to a care plan and we’re able to demonstrate we’re seeing improved outcomes.”
To demonstrate the value of early intervention, Shoppers recently conducted a pilot in 40 pharmacies over three months to screen people aged 40 and older and not currently on diabetic medications. After screening close to 10,000 patients, the company found 19 per cent were either pre-diabetic or diabetic and not diagnosed and 43 per cent were at higher risk of becoming diabetic over the next 15 years. Twenty-eight per cent didn’t have a family physician.
“We can catch those people earlier on [and] we can get them on behavioural or lifestyle changes, so we’re really slowing the progression of diabetes,” she said.