Managing diabetes in order to prevent or delay the common complications of the disease – such as heart disease and stroke, amputation, kidney failure, depression and blindness – is a challenging, 24/7 job. But for Stacey Livitski, the health-care realities of living in a northern community have made that job significantly more difficult.
While there are thousands of people with diabetes and prediabetes in Thunder Bay, the region where she lives, there is just one endocrinologist in residence at a time. “When that endocrinologist leaves, there tends to be gaps of months or even years before another arrives,” says Ms. Livitski.
The community’s single endocrinologist treats not only people living in Thunder Bay who are affected by diabetes and other hormone-related diseases, but also the residents of the region’s rural communities, so the usual wait time for an appointment is about six months. “He cannot see everybody, because there are just too many of us,” she says. “We don’t even have a pediatric endocrinologist, so when children are diagnosed here they have to wait up to a year to see a specialist. It’s hard.”
Long wait times often have implications beyond the delay in care. For example, Ontario’s Assistive Devices Program provides much-needed funding for insulin pumps, but requires that the patient be under the treatment of an endocrinologist. “In order for me to receive my pump funding, he needs to sign off to say that I’m doing okay. I worry – our endo is overworked and getting older. If he retires and they don’t have anyone lined up, what will happen?”
Thunder Bay does have a diabetes clinic that Ms. Livitski relies on to help her manage her insulin dosages and for other care and advice, but there are times that only an endocrinologist can help. “People with type 2 diabetes who depend on oral medications – like my mom – need an endocrinologist to make any medication changes. So if she’s not doing well, she just has to wait. It’s a big issue, because we have a very high population of people with diabetes in northwestern Ontario, especially with type 2,” she stresses.
After living with diabetes for more than 30 years, Ms. Livitski has diabetic peripheral neuropathy, a common complication of advanced diabetes. Nerve damage in her feet and lower limbs puts her at high risk of severe chronic pain, infection and even amputation. She worries about getting the care she needs in that regard as well. “We have two chiropodists in our hospital, so the waiting list is a year long, even if it’s an emergency.”
According to the Canadian Diabetes Association’s Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada and Standards for Diabetes Education in Canada, people with diabetes have a right to timely, affordable and ongoing diabetes education and comprehensive treatment services, provided with seamless co-ordination by a diabetes health-care team and other specialists.
“Diabetes is one disease where modest up-front investment can result in significant future savings to the health-care system,” says Joan King, manager, outreach and individual advocacy, Government Relations and Public Affairs, at the Canadian Diabetes Association. “Long waiting lists often mean that many people with diabetes never receive appropriate education about diabetes and self-care.”
She adds that, although diabetes management requires a sustained commitment on the part of the individual with diabetes as well as timely, effective and co-ordinated care on the part of the providers, the benefits can be great. “Only effective management can delay or prevent complications.”