Ralph Waldo Emerson once said that money often costs too much. So does having diabetes, according to a study by the American Diabetes Association (ADA).
The study in the journal Diabetes Care looked at healthcare spending on diabetes based on national data from 1987 to 2011. According to the latest data analyzed in 2010-11, Americans with diabetes spent an average of $5,378 more than Americans without it. Of a $2,790 increase on average compared to 1987, the cost of prescription drugs accounted for 55 percent of the amount.
“The spending on prescription medications has been the most important driver of diabetes-related medical cost increases in the last two decades," says the lead author, Xiaohui Zhou of the Centers for Disease Control and Prevention (CDC).
“This has been driven by two factors: first, patients now are taking more medications, in part due to more intensive control on glycemic and other risk factors in current practice than that in the past; and second, the prices of those medications have increased significantly,” he adds. “The increase is fueled by the much higher prices of newer drugs.”
The price of some newer drugs could “easily” be eight to 10 times higher than the cost of an older drug, sulfonylureas; it’s five to 10 times higher for metformin, a drug that has been used in the U.S. since 1995. Metformin is probably used more than any other diabetes-related drug in the world; in the United States alone, more than 48 million prescriptions were filled in 2010 for its generic equivalents.
Zhou does temper his comments by noting that the development and distribution of newer drugs and medical devices, such as home blood sugar meters, provide a wider range of treatment options for people with diabetes, especially those who have trouble managing their blood glucose.
Could the study have a silver lining, one that motivates you to make lifestyle changes to lower your need for medications, or maybe eliminate them altogether – reducing your healthcare costs?
In a review of ways to prevent or delay the onset of type 2 diabetes in Diabetes Care, the ADA says that metformin was less effective than lifestyle changes recommended by the Diabetes Prevention Program (DPP). The major, multicenter clinical research study looked at whether moderate weight loss through changes in diet and exercise or use of metformin could prevent or delay the onset of diabetes.
Even delaying the onset of diabetes is important: the longer you have it, the more likely you are to develop debilitating diabetes-related complications that could shorten your life.
To put it plainly, if you get up from the couch and start moving around regularly, while eating a healthy diet with fewer processed foods full of salt and refined sugar, you might never develop diabetes in the first place. In the very least, you might delay the onset of diabetes.
Matt Petersen, longtime managing director of medical information for the ADA, says that while the data in the diabetes cost study is conclusive, you also have to consider the cost-benefit ratio of improved treatments for diabetes.
He notes, for example, that from 1990 to 2010 — roughly the same time span of the diabetes cost study — rates of five common complications from diabetes decreased significantly. Those included heart attack (68 percent), stroke (53 percent), amputation (51 percent), end-stage renal disease (28 percent), and deaths from high blood glucose crisis (2.7 percent).
“Its definitely true in this (study period) a lot of things changed about medications available to manage diabetes and the number of people using them,” he says. “This was an incredible period of time. It wasn’t until 1993 that it was conclusively demonstrated that controlling blood glucose levels actually reduced the rate of complications from diabetes.
“It’s easy for us to lose sight of the fact that just 20 years ago, there was serious debate about that. We tend to think that we’ve always known that controlling blood glucose levels was beneficial, but actually for decades there was a very strong back and forth contention that, no, it didn’t really matter much as long as you stayed alive. There was a very strong believe that if you were okay day to day that other things were causing these complications.”
During the same time period, research also opened the doors to more use of blood pressure and cholesterol drugs, both effective in reducing risk of cardiovascular disease, a major complication of diabetes. About 65 percent of people with diabetes die from a heart attack or stroke, according to the National Diabetics Education Program.
“The DDP for type 2 diabetes also showed there were lower medication costs,” Petersen says. “People were using fewer total prescription drugs, including those for blood pressure and cholesterol, if they were in the group that was in the prevention program.
“I’m a strong advocate of the term pre-diabetes for the fact that it’s a good motivator for people to make lifestyles changes. Who would make those changes otherwise? We make it sound easy, but it’s not. We are biologically driven to take in those calories.”
April 03, 2015
Janet O’Dell, RN