Medical students at Memorial University have a critical role to play in advocating for patients to receive equitable health-care services.
We recognize the vast impact of diabetes on people throughout Newfoundland and Labrador.
In this province, there is one amputation every 55 hours due to diabetic foot ulcers (Diabetes Canada, 2018).
Interventions are available
Offloading devices are an intervention that limit pressure on ulcers, allowing them to heal.
These devices are often paid out-of-pocket and can be a substantial cost to individuals, limiting their accessibility.
By publicly funding offloading devices to patients with diabetes, there will be improved health outcomes as well as financial savings for the Government of Newfoundland and Labrador.
One in 10 Canadians live with diabetes. In this province, the impact of the condition and the detrimental complications that result are profound.
It was estimated that 13 per cent of people in Newfoundland and Labrador were living with diabetes in 2019 (p. 1).
These rates are projected to reach 15 per cent of the provincial population by 2029 (p. 1).
These numbers, reflecting rates that are significantly greater than the national average are, sadly, just the beginning.
Specific populations, such as Indigenous Peoples and residents of rural areas, are shown to experience higher rates of diabetes, and face more substantial limitations in accessing care (p. 2).
These groups make up a significant proportion of this province, which results in unique challenges for the province in preventing diabetes and meeting the needs of those affected.
Invest in prevention now
One of the main complications for diabetic patients is foot ulceration and infection.
This ulceration can worsen over time and lead to the need for amputation. The most effective way to intervene for diabetic foot ulcers is an offloading device.
The gold standard offloading device, called a total contact cast, is a cast and customized boot that reduces pressure on the ulcerations to allow for proper healing.
“Diabetes disproportionally affects those that are socially disadvantaged and living on a low income.”
We are advocating for this preventative approach, which means investing now in programs that will lead to improved health outcomes in the near future.
Annually, the direct costs associated with diabetic foot ulcer care, such as physician payments and hospital costs, is $16-$18 million (p.15).
At an individual level, an offloading device can cost between $300-$1,800 (p.9).
This is a significant cost to incur, especially when considering that diabetes disproportionally affects those that are socially disadvantaged and living on a low income.
Support individuals now, pay less later
It is estimated that the implementation of a provincial offloading device program would cost approximately $1.6 million annually (p.13).
However, with this program in place, it is estimated that the government will save a net of $4-$5 million annually (p.13).
This investment makes financial sense for the province, all while giving patients the crucial means to prevent and treat their foot ulcerations.
“We must balance preventative measures that focus on both short-term and long-term progress.”
Although this is unlikely to be an investment that the government will take lightly, the research shows a clear financial benefit for the province in responding to this call to action.
Some may suggest that further upstream approaches, such as investments in healthy eating programs, and a focus on the social determinants of health would be a more appropriate investment.
While diabetic prevention and early management programs are crucial, we must balance preventative measures that focus on both short-term and long-term progress.
Presently, Ontario is the only other Canadian province to offer full coverage for offloading devices.
Newfoundland and Labrador has an important opportunity to lead the country in diabetes management.
This is an issue that impacts the people of Newfoundland and Labrador disproportionately compared to the rest of the country.
“The amputations that occur as a result of diabetic foot ulcers are completely avoidable.”
Now is the time for our government to respond appropriately and acknowledge the severity of this situation.
The amputations that occur as a result of diabetic foot ulcers are completely avoidable and we present a clear solution.
By funding offloading devices for patients with diabetes to prevent and treat foot ulcers, Newfoundland and Labrador would be taking a step in the right direction.
A step that addresses a pertinent issue of health inequity in the province, a step that will improve the quality of life for many Newfoundlanders and Labradorians and a step that is financially justified.
Annually, medical students at Memorial University organize Provincial Days of Action to bring awareness to a gap in the health-care system and advocate for change. From March 22-26, the students will meet with policy-makers to present their research and demonstrate the importance of addressing these gaps.
The authors thank the research team, the Provincial Day of Action working group and the past chair of the event, Rebecca Matthews, for their diligent efforts in preparing everyone for the Provincial Days of Action this year.