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Diabetes: Profits Before Evidence

What if most of the bleeding and checking blood sugar levels is a waste of time, does almost nothing to control your diabetes, makes you anxious or depressed and threatens the sustainability of the public health-care system?

Diabetics today are very familiar with a modern form of blood-letting, which involves stabbing themselves in a finger to draw blood. By smearing blood on a glucose test strip and inserting it into a machine, you can find out how much sugar is in your blood. Some people repeat the procedure up to eight or 10 times a day.

But what if most of that bleeding and checking is a waste of time, does almost nothing to control your disease, makes you anxious or depressed and threatens the sustainability of the public health-care system?

This seems to be the case, at least according to some of the best independent health information around, which advises that frequent checking of blood glucose, by people who don't use insulin, is not a good idea. It leads to anxiety and depression, while the test strips, at about a dollar each, lead to unnecessary spending of hundreds of millions of dollars annually.

Blood-sugar testing is an essential activity for insulin-dependent diabetics, those people who are born with diabetes or develop it as a child.

However, more than 80 per cent of the people with diabetes are Type-2 diabetics who typically develop it in adulthood and need to control their blood sugar by exercising and modifying their diet.

Some drugs might help to prevent the complications of diabetes, but frequent testing of their blood sugar? Not wise, according to the Canadian Agency for Drugs in Technology and Health, which issued a report last year saying that too-frequent checking of blood sugar is unnecessary and potentially harmful. A report from Ontario last year estimated that the waste on unnecessary test strips was somewhere between $20 million to $40 million per year.

So given what the agency says, and extrapolating across the country, Canadians could be wasting somewhere between $50 million to $100 million each year on unnecessary test strips (according to a low-end calculation made from a study, which showed annual public expenditures from eight public drug plans in Canada on test strips was $247 million, of which half is probably unnecessary). Imagine what kind of serious diabetes prevention you could fund with that kind of money.

As far as I can tell, only one province up to now has tried to rein things in. A year ago, Nova Scotia decided it was going to try to put a stop to the waste and harm caused by the overuse of diabetes test strips and capped the number of strips it would cover for non-insulin-dependent diabetics. This sounded like a reasonable thing to do and I admired their pluck.

But within a day of announcing the policy, they retracted it. Like most times when public health agencies are attacked for saving money they faced "the sky is falling" rhetoric from the affected patient group. Pressure from the diabetes industry and the Canadian Diabetes Association can be pretty fierce, especially given the fact their activities are partially bankrolled by the biggest drug companies on the planet. They put little Nova Scotia back in its place.

That's unfortunate.

Nova Scotians could have saved $3 million a year and reinvested it in prevention (they spent about $6 million per year on test strips half which is likely unnecessary). But such a policy would upset the funded patient groups and a powerful group of companies pushing test strips, glucometers -machines that read the test strips -drugs and other diabetes paraphernalia.

Over the past decade, the marketing of blood testing for Type-2 diabetics has intensified, with more emphasis on getting mildly diabetic people to test and retest, causing them to obsess about their numbers. If test strips were drugs they would be one of the top five most costly items on provincial drug plans, a cost that has ballooned enormously in the last five years.

This is insane. No one wants to needlessly test their blood every day, yet fear-mongering rhetoric continues to drive people to test their blood sugar frequently, with warnings that doing so will prevent kidney disease or blindness, even though that's not true.

Will we ever see governments stand up to this vast diabetes ripoff? The bigger provinces seem even more cowardly than plucky little Nova Scotia in taking on the coalition of diabetes profiteers. Governments such as the one in B.C. say they want to focus on better diabetes education and clearly that's needed, but they don't seem interested in funding it by cutting the gross amount of waste involved.

We expect governments to make evidence-based health decisions. We expect them to examine the best science and make coverage policies based on that science. We certainly don't expect them to cower in front of the Goliaths of the diabetes industry, where an ongoing need to make people bleed -for profit -is becoming more and more unsustainable and unbelievable.

Alan Cassels is a drug policy researcher at the University of Victoria and an expert advisor with, a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada.

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