November 2018; 60:9 Pages 421–472 Diabetes in British Columbia: Starvation in the midst of plenty Challenges to managing type 2 diabetes in BC: Discordant guidelines and limited treatment options Diabetes care in First Nations populations in BC From beta cells to bedsides: A 2018 update on diabetes research in BC www.bcmj.org 422 BC MEDICAL JOURNAL VOL. 60 NO. 9, NOVEMBER 2018 bcmj.org November 2018 Volume 60 • Number 9 Pages 421–472 contents 425 Editorials Rhinos, take 2, David R. Richardson, MD (425) Knock, knock, it’s the doc, Jeevyn Chahal, MD (426) 427 President’s Comment Come together, right now: Why diversity matters, Eric Cadesky, MD 428 Letters to the Editor Photo radar, and stories from those close to people killed by a fast-moving vehicle, Robert Shepherd, MD ON THE COVER 430 WorkSafeBC British Columbia has Canada’s Engaging with research at WorkSafeBC, Susan Dixon most restrictive formulary when it comes to diabetes treatment. Our theme issue highlights both 432 General Practice Services Committee the highs and the lows of caring for people with diabetes in BC. New GPSC incentive supports family doctors to implement panel Articles begin on page 436. management, Brenda Hefford, MD, Alana Godin 434 News Eric Zhau receives Canadian Medical Hall of Fame award (434) Screening tool to identify deceptive online ads (434) New device for post-prostatectomy urinary incontinence (435) The ultrasound scanner of the future? (435) Revamped mental health and substance use website for young people The BCMJ is published by (464) Doctors of BC. The journal provides peer-reviewed clinical and review articles written primarily by BC physicians, Clinical Articles for BC physicians, along with debate on medicine and medical politics in editorials, letters, and THEME ISSUE: DIABETES CARE essays; BC medical news; career and CME listings; physician AND MANAGEMENT profiles; and regular columns. Print: The BCMJ is distributed monthly, other than in January 436 Guest editorial: Diabetes in British Columbia: and August. Starvation in the midst of plenty Web: Each issue is available at Ehud Ur, MBBS www.bcmj.org. Subscribe to print: Email [email protected]. 439 Challenges to managing type 2 diabetes Single issue: $8.00 Canada per year: $60.00 in British Columbia: Discordant guidelines Foreign (surface mail): $75.00 and limited treatment options Subscribe to the TOC: Maureen Clement, MD, Breay Paty, MD, G.B. John Mancini, MD, David Miller, MD, To receive the table of contents Adi Mudaliar, MD, Dave Shu, MD, David Thompson, MD, Adam White, MD, by email, visit www.bcmj.org and click on free e-subscription. Ehud Ur, MBBS Prospective authors: Consult the “Guidelines for Authors” at www.bcmj.org for submission requirements. BC MEDICAL JOURNAL VOL. 60 NO. 9, NOVEMBER 2018 bcmj.org 423 contents BC Medical Journal Vancouver, Canada 604 638-2815 451 Diabetes care in First Nations [email protected] populations in British Columbia www.bcmj.org Keith G. Dawson, MD 455 From beta cells to bedsides: A 2018 update Editor David R. Richardson, MD on diabetes research in British Columbia C. Bruce Verchere, PhD Editorial Board Jeevyn Chahal, MD David B. Chapman, MBChB Brian Day, MB David Esler, MD 460 Obituaries Timothy C. Rowe, MB Dr Richard Wadge, Alex Wadge (460) Yvonne Sin, MD Benedict M. Garry, MD (460) Cynthia Verchere, MD Dr John Daniel Garry, Dr Fred Ceresney, Alister F. Frayne, MD (461) Managing Editor Jay Draper Senior Editorial and 462 BC Centre for Disease Control Production Coordinator Kashmira Suraliwalla Raccoon latrines and risk of Baylisascaris transmission Associate Editor Erin Fraser, DVM, Eleni Galanis, MD, Muhammad Morshed, PhD, Joanne Jablkowski Copy Editor 463 Barbara Tomlin Council on Health Promotion Proofreader Climate change and infectious disease in Canada and BC Ruth Wilson David McVea, MD, Ray Copes, MD, Eleni Galanis, MD Design and Production Scout Creative 465 CME Calendar Cover Concept & Art Direction Jerry Wong Peaceful Warrior Arts 466 College Library Printing DynaMed available through College Library, Robert Melrose Mitchell Press Advertising Kashmira Suraliwalla 467 Guidelines for Authors 604 638-2815 [email protected] 468 ISSN: 0007-0556 Classifieds Established 1959 470 Back Page Opting out (Nanaimo 1992), Paul Mitenko, MD 471 Club MD Postage paid at Vancouver, BC. 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Doctors of BC does not assume responsibility or liability for damages arising from errors or omissions, or from the use of information or advice contained in the BCMJ. The BCMJ reserves the right to refuse advertising. 424 BC MEDICAL JOURNAL VOL. 60 NO. 9, NOVEMBER 2018 bcmj.org editorials Rhinos, take 2 “ his year, as another flu sea- “Sure, but they are rare. Where’s “But you’re a physician.” son begins, I’m going to try your sense of adventure?” “Yeah, but not a very good one— T a different approach with my “I’m feeling a little uncom- just ask my wife. She tells everyone. patients to conserve all the energy I fortable.” I’m just in it for the fame and fortune.” expend trying to educate them (see “But you don’t have a car and you my editorial in the Jan/Feb 2017 is- I’m sure that, aren’t famous.” sue, “Of rhinos and flu”). “Regardless, that flu shot causes like all of you, I will “Hey Doc, do you think I should all sorts of problems. Lots of my pa- get the flu shot?” soldier on instead and tients get colds after receiving the “Nope.” present logical vaccine and last year one of my pa- “Why not?” scientific arguments tients got into a car accident after re- “Haven’t you heard? That shot until I am once again ceiving the shot.” gives you the flu!” blue in the face. “Isn’t that a coincidence?” “What?” “That’s what they would like you “Well, it contains parts of the flu to think.” virus, which are injected into you.” “But wait, that’s not all.” “Who are they?” “That doesn’t sound good.” “There’s more?” “Everybody knows who they are, “I know. It’s horrible. Your “The flu shot takes time to pro- but I can’t talk about it here in case body’s immune system responds and duce so scientists have to decide they have my office bugged again.” you might even feel unwell for a few months ahead of time which strains “Are you sure you’re not one of hours. Can you imagine? Way better to include, and the last few years those impaired physicians?” to fight it off bedridden for a week they haven’t been very accurate. Of “Define impaired.” or 2.” course, there is some cross-protection So, okay, maybe not, but it’s still “Really?” to other strains, but whatever.” fun to think about going to the dark “Oh yeah, always better to get the “Isn’t protection a good thing?” side. However, I’m sure that, like all disease. What would I do if no one got “My advice is to hang out with of you, I will soldier on instead and sick?” people who get the flu shot and stay present logical scientific arguments “Aren’t there serious complica- away from the sickies. That’s what I until I am once again blue in the face. tions from getting the flu?” do.” —DRR BC MEDICAL JOURNAL VOL. 60 NO. 9, NOVEMBER 2018 bcmj.org 425 editorials Knock knock, it’s the doc “ nock knock.” tucked in with lots of blankets and ing a patient’s health over the phone. “Who’s there?” facing an amazing view. He is pale Telehealth and virtual house calls K “Your doc.” and unresponsive and remains that are becoming the new fad. Telemedi- “Your doc who?” way throughout the visit. cine limits the doctor’s ability to actu- “Your family doctor.” Mrs and Mr S. are both my pa- ally see the patient and to assess the “What?! No way!” tients. His health declined rapidly patient’s real environment. We also The door swings open and there over the past few years to a point forget that many patients do not have she stands, Mrs S., with a genuine where his Parkinson disease and de- the technological savvy or the appro- smile on her beautifully wrinkled mentia made it difficult for Mrs S. to priate device required to conduct a face. Her smile widens even more virtual house call. when she sees that I have my 3-year- A house call is an There have been a few survey old daughter in tow. She opens her eye-opener. It usually takes studies done to assess physicians’ arms for a hug and welcomes us into thoughts about house calls. A study about 30 minutes and it her home. It is a very tidy and orga- cited in the Canadian Family Phy- nized space full of knickknacks and is not structured.