Should we be doing more to prevent and manage Type 2 diabetes?
Diabetes, in terms of how many people are affected and the impact it has on their lives, may well be the single biggest chronic health issue in today’s workplace.
It is now also the single biggest driver of cost in prescription drug plans.
According to a report from TELUS Health, diabetes-related medications topped the list of drug claims costs at 12.9 percent of the total – which it reports is a staggering 29.4 percent increase since 2022.
TELUS notes that increases in diagnosis of diabetes or pre-diabetes have driven up costs in recent years – and are expected to continue as the population ages – but that the biggest drivers of increased cost, by far, are increased use of diabetes drugs for the treatment of heart failure and for weight loss.
According to Health Canada, about 3.8 million people over the age of one year, or about 9.6 percent of the population, have been diagnosed with diabetes. In addition, at least 6 percent of Canadians fall into the category of “pre-diabetes” which makes them susceptible to developing Type 2 diabetes later in life.
It is important to note that there are essentially two different types of diabetes. Health Canada states that Type 1 diabetes, which typically develops early in life, occurs when the body’s own immune system attacks the insulin-producing cells in the pancreas, leaving the sufferer unable to produce the insulin that is vital to managing sugar in the body.
About 5 to 10 percent of diabetes patients suffer from Type 1. There is currently no known cure, and patients rely on regular doses of insulin to manage the condition.
Type 2 diabetes, which accounts for 90 to 95 percent of cases in Canada, tends to develop gradually later in life, with most diagnoses occurring after age 40 (although Health Canada notes that earlier incidence is becoming more prevalent). Type 2 patients either do not produce enough insulin or have difficulty in utilizing the insulin that their bodies produce.
Type 2 diabetes is often associated with being overweight or obese and can to some extent be managed with weight loss, exercise and a healthy diet designed with diabetes management in mind.
Much of the cost and almost all of the recent growth in drug cost is accounted for by new treatments for Type 2 and, of course, the new GLP-1 weight loss drugs. Some of these drugs, such as Ozempic, the first to make a splash on the scene, were strictly designed to manage diabetes, but were found to have weight-loss applications. As a result, “off label” prescribing for weight loss quickly took off.
The second wave of GLP-1 drugs, such as Wegovy, are specially indicated for weight loss.
Managing diabetes and losing weight might, at first glance, appear to be two totally different things, but they are also very clearly related: losing weight is the first thing an overweight Type 2 patient is advised to do.
It does not come as a surprise, therefore, that benefits plan members are increasingly asking for coverage of GLP-1 drugs, and that plan sponsors are responding.
According to a report from the International Foundation of Employee Benefit Plans, 56 percent of Canadian drug plans cover GLP-1s for diabetes only, while 31 percent cover them for weight loss as well.
However, almost all employers are taking cost-management measures such as applying eligibility requirements, annual maximums per member, and utilization management.
Of the 68 percent of employers who cover GLP-1s and apply some degree of utilization management, almost all require prior authorization and 27 percent require authorization of refills.
According to the Designed for Health report from Sun Life, there is a strong correlation between chronic conditions – and diabetes in particular – and plan members using long-term disability (LTD).
Those on LTD were almost three times more likely to be living with diabetes in addition to the primary condition responsible for their being on LTD. In fact, the majority of claimants were dealing with more than one chronic condition.
Blue Cross reports that 41 percent of its members claimed at least one chronic condition, such as diabetes and that, of those claimants, 28 percent claimed two chronic conditions and 17 percent claimed three of more.
They also report that weight management drugs had jumped into third spot as drivers of cost, with an increase in claims of 150 percent over 2023.
According to Health Canada, Type 2 diabetes – which is by far the most prevalent form, and which is associated with many secondary effects – is to a considerable degree both preventable and manageable.
The first thing that most of us can do on the prevention side is to do an assessment of our level of risk – best done in consultation with a family physician or other healthcare provider.
The factors to look for are as follows (again, according to Health Canada):
- prediabetes
- getting older (late 30s and up)
- high cholesterol
- physical inactivity
- high blood pressure
- being overweight or obese
- a history of gestational diabetes (or diabetes during pregnancy)
- a family history of type 2 diabetes
Health Canada states that, while it is not possible to control all risk factors, and while each individual is different, it is still possible to greatly reduce the risk of developing Type 2 diabetes – or even reversing its effects.
The lifestyle changes they recommend are as follows:
- don’t smoke
- maintain a healthy weight
- limit alcohol consumption
- get enough sleep and rest
- eat a variety of healthy foods
- be physically active every day
- manage high blood pressure, cholesterol and glucose
You should also get screened or tested for diabetes regularly and report any new signs and symptoms to your healthcare provider.
Click here for a terrific guide to exercise, education, lifestyle coaching, motivation and support from the Central East Regional Cardiovascular Rehabilitation Program.
I really appreciate comments, ideas, suggestions or just observations about the blog or any other topics in benefits management. I always look forward to hearing from readers. If there’s anything you want to share, please email me at bill@penmorebenefits.com.
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