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Opinion Americans with diabetes face an insulin crisis – but Canada is no paradise, either

Jan Hux is the president and CEO of Diabetes Canada.

Canadians have so much to be proud of in their history, and one part of that proud heritage is that this is the birthplace of insulin – a hormone discovered by Frederick Banting and Charles Best that has transformed the lives of people living with type 1 diabetes.

Recent news about insulin “caravans” coming from the United States might contribute to our sense of good fortune at being Canadian. The stories of U.S. citizens who struggle to pay upwards of US$340 for each vial of insulin, a therapy they cannot possibly live without, are heartbreaking. And the debate about the unsustainable costs of living with type 1 diabetes in that country has reached the presidential campaign, with Democratic hopeful Bernie Sanders joining one such insulin shopping trip to Windsor, Ont., this past weekend.

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Their trip to Canada to find affordable insulin paints a rosy picture of our health-care system. But while feeling smug relative to the U.S.'s health-care system is a bit of a national pastime, many of the 300,000 Canadians living with type 1 diabetes face significant difficulties. Insulin may be more affordable in Canada – but our picture is hardly perfect.

Type 1 diabetes is an autoimmune disease for which daily insulin injections are lifesaving, and the cost of such medication remains a barrier to achieving optimal health outcomes. A lack of co-ordination in health services and across sectors, a failure to rigorously monitor service and outcomes, and our current patchwork approach to treatment across the country contributes to the difficulties Canadians living with type 1 diabetes face.

About 15 per cent of Canadians with diabetes have no insurance to pay for their insulin, and many more are underinsured. Private group plans offer different levels of reimbursement, but not all employers provide prescription drug coverage. Co-pays and deductibles may also be prohibitive. Many people must choose between paying for essentials such as food, rent and utilities, or obtaining their life-sustaining insulin. Some choose to reduce their insulin dose to save costs, but even if they are able to avoid dangerously high blood-glucose levels requiring hospitalization, the resultant mildly elevated levels over time greatly increase the risk of long-term complications, such as amputation and blindness.

The cost of insulin isn’t the only one that people with type 1 diabetes have to endure. There are two other associated expenses: equipment that identifies how much insulin to take, and needles to get it into their bodies.

People with type 1 diabetes must test their blood sugar levels multiple times daily to determine how much insulin to inject. Test strips required to measure the glucose in a finger-stick blood sample cost $1 each. People with type 1 diabetes use five a day on average, and 10 or more when glucose levels are unstable.

Insulin must be injected, which requires access to syringes and needles, coming in at another $100 a month. Coverage for insulin pumps, which offer an alternative to multiple daily injections, is also inconsistent across Canada. Canadians in provinces with limited coverage must pay a whopping $6,000 to $7,000 for the device and absorb the ongoing monthly costs of supplies.

So, while the unfortunate news from our neighbours to the south is alarming, we cannot ignore the reality of managing this costly disease in our own backyard. And considering recent reports that the U.S. administration will allow importation of prescription drugs, we cannot dismiss the potential risk of shortages at home. We must take immediate measures to protect the supply of insulin that Canadians with diabetes rely on to live.

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We need co-ordinated, evaluated care that provides optimal health outcomes. Diabetes 360˚ – a nation-wide strategy to address the epidemic of diabetes in Canada – provides a framework to coordinate the efforts of actors across sectors, and aims to create an environment that promotes health and wellness, increases screening for diabetes, monitors health outcomes, and removes barriers of access to care and medications, including insulin. Canada has been without a national diabetes strategy for six years, and Canadians are suffering the consequences – and if we don’t get that in order, the U.S.'s efforts to make itself great again might make that mission all the more difficult.

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