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Rising cost of diabetes

A week ago Thursday was World Diabetes Day. It didn’t get much, if any, play in the media, so you probably didn’t notice. To raise awareness of the growing health threat of diabetes, the United Nations designated Nov. 14 as World Diabetes Day. The International Diabetes Federation (IDF) website notes World Diabetes Day, “is the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922.”

For those with diabetes, every day is diabetes day. Statistics from the American Diabetes Association (ADA) indicate more than 30 million Americans have diabetes; for some perspective, that is more than one and a half times larger than the entire population of NYS. Shockingly, the ADA also notes 84 million Americans have prediabetes, which means they are at risk of developing diabetes, and every day 4,110 Americans are diagnosed with diabetes.

Even if you don’t have diabetes, it’s likely one or more of your family members or friends do. Diabetes is on the rise and the costs are staggering. There are some reasons for optimism, though, as, for some people, the most prevalent form of diabetes is preventable with appropriate diet and exercise, and a great deal of research is being done to find new treatments and possibly cures.

Wallet-killing costs

The accompanying chart shows the staggering and rising costs of diabetes have far outrun inflation over the last ten years. Of course, a large part of the increased costs reflects the growing number of people diagnosed with diabetes. Both direct costs and indirect costs are on the rise. Direct costs include health care expenditures, such as prescriptions and doctors visits, while indirect costs include reduced performance and productivity in the workplace as well as on the home front. The ADA report Economic Costs of Diabetes in the U.S. in 2017 notes, “The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity [and] care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S.”

Part of the increased costs is also attributable to the convoluted insulin market. The February 2019 article “‘Everyone is at fault’: With insulin prices skyrocketing, there’s plenty of blame to go around” by Nicolas Florka, a reporter for STAT, which is an affiliate of the Boston Globe and reports on “life sciences and the fast-moving business of making medicines,” notes “fifteen years ago, a patient with diabetes might have paid $175.57 for a 20-milliliter vial of the long-acting insulin Humulin R U-500. Today, [the patient would] shell out $1,487 for the same tiny vial.”

It’s not just the drug companies that are to blame; Florka also notes, “a thorough review of the drug’s nearly 100-year history reveals a much more complicated story: one that makes it clear that the drug makers, their generic counterparts, doctors, and, increasingly, the Food and Drug Administration itself all share blame for the broken insulin market.”

Similarly, the April 2019 Reuters article “Sanofi to cut U.S. insulin costs for some patients to $99 per month” by Michael Erman says, “The cost of insulin for treating type 1 diabetes in the United States has nearly doubled over a five-year period, leading some patients to put their own health at risk by rationing the medication.”

Not surprisingly, the insulin market has attracted the attention of Congress. In April 2019, Congress held hearings with the main producers of insulin as well as companies that manage drug benefits. Apparently, congressional pressure caught the attention of the drug makers. Erman’s article noted, just hours before the hearing, Sanofi SA one of the main manufacturers of insulin said “it will cut the cost of its insulin products to $99 per month for uninsured patients and others who pay cash for it in the United States, as the French drugmaker contends with intense criticism over the high price of the life-sustaining diabetes medication.”

Marie Gray, who has type 1 diabetes and is a licensed diabetes therapist with a practice in Austin, Texas, recently discussed the cost of her diabetes meds with me. On top of the $450/month she pays for health insurance, she also pays more than $750/month for insulin. Ms. Gray, whose specialty is working with newly diagnosed type 1 teenagers and young adults as well as their families, notes “insulin truly is a wallet-killer.”

Causes

The various types of diabetes, which include type 1, type 2, gestational, and prediabetes have a variety of causes. People who are diabetic either don’t produce insulin or their bodies don’t use insulin properly. According to the ADA, that’s a problem because “the body breaks down the carbohydrates you eat into blood sugar that it uses for energy — and insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body.”

The IDF website notes, “the exact causes of [type 1] are not yet known, butare linked to a combination of genetic and environmental conditions. At present, type 1 diabetes cannot be prevented.” The IDF also notes, “type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes cases. It is generally characterized by insulin resistance, where the body does not fully respond to insulin.”

Therapist Marie Gray also recently explained to me the confusing nature of the various forms of diabetes.

Gray noted one of her lifelong frustrations has been “why in the WORLD they couldn’t give type 2 diabetes a different name all together” from type 1. Her frustration stems from an incident when, as a 10-year old child, she was diagnosed with diabetes and was told “it would go away.” It didn’t go away because she had type 1 rather than type 2. Gray says that was a devastating “thing to tell a child being diagnosed with a life-changing disease.”

Calls to action

The International Diabetes Federation “estimates that as many as 212 million people, or half of all adults currently living with diabetes, are undiagnosed.” The first step in treating or preventing diabetes is recognizing your risk; to that end, the IDF has an interactive, self-assessment tool in 12 different languages at www.idf.org/type-2-diabetes-risk-assessment/. Check it out.

More than 43,000 have taken the IDF’s free, TEST2PREVENT, which only asks eight questions related to your age, weight, exercise, diet, blood pressure, blood glucose level, and family history of diabetes. The test asks for your height in centimeters and weight in kilograms, which is a little annoying, but a simple Google search on “inches to cm” and “pounds to kg” readily opens converters.

The ADA has a similar 60-second Type 2 Diabetes Risk Test at www.diabetes.org/risk-test where you need not convert inches to centimeters and pounds to kilograms. The IDF’s and ADA’s tests are not substitutes for an assessment from your physician.

The IDF’s World Diabetes Day is a call-to-action to unite “people with diabetes, health professionals, diabetes advocates, media, the general public and government organisations in the fight against diabetes.” One way you can join the fight is by participating, or sponsoring participants, in the ADA’s Tour de Cure, which “is the premiere fundraising event of the ADA” where participants bike ride, run, or walk.

In my discussion with Gray she noted another more personal way to fight or prevent diabetes, especially for those who have prediabetes, is to “avoid fast food, high fructose syrup, and loads of sugar and to exercise because it helps break down sugar and fat so your pancreas gets to take a little break.” New Year’s resolutions anyone?