When I heard that my patient was back in the ICU, my heart sank. But I was not surprised. Her pay is usually low at the end of the month, so does her insulin. As she increases her supply, her blood sugar rises. Soon there is an insatiable thirst and frequent urination. And as soon as his keto acid builds up, he starts having stomach pain and vomiting. She is always taken to the hospital before damage to her brain and heart occurs. But we both worry that someday she won’t do it.
The Inflation Reduction Act, passed last month, aims to help people like him by reducing the cost of insulin across America. Although there were efforts to expand protection to privately insured Americans blocked in the SenateDemocrats succeeded in limiting drug spending on Medicare among Americans to $35 a month, offering Meaningful savings for our seniors, some of which will save hundreds of dollars a month thanks to the measure. In principle, the policy (and similar people at the state level) would help estimated 25 percent of Americans on insulin who are forced to ration the medicine because of the cost, and will stop some of them 600 Annual US Deaths The fate I am trying to save my patient from, from diabetic ketoacidosis.
In fact, laws limiting co-pays for insulin are both welcome news. financially And medically For patients who depend on the drug for survival. However, in their current version, such laws could backfire, leading to even higher overall diabetes-related deaths.
How can this be true? Thanks to the development of new drugs, the role of insulin in the treatment of diabetes has been declining over the past decade. It is needed for a small percentage of patients with type 1 diabetes, including my patient. but for 90 percent of Americans with diabetes who have type 2it doesn’t have to be regular first-, second-, or even third-line treatment, There are several reasons for this: Insulin carries the highest risk of all diabetes medications. dangerously low blood sugar, The drug usually comes in injection form, so administering it usually means painful needle jabs. All this effort is rewarded (usually unwanted) weight gain, Most important and lastly, although insulin is excellent at reducing high blood sugar—diabetes identification and driver of some of its complicationsIt is not as effective as other drugs in reducing the most deadly and debilitating consequences of the disease: heart attack, kidney disease and heart failure.
Large clinical trials have shown that two new classes of diabetes drugs, SGLT2 inhibitors and GLP-1 receptor agonists, better performance options (including insulin) to reduce the risk of these disabling or fatal outcomes. Giving these drugs to patients instead of the old options over a period of three years protects fromon average, About one death for every 100 treatments, And SGLT2 inhibitors and GLP-1 receptor agonists carry a low risk of causing dangerously low blood sugar, usually don’t require frequent injections, and help patients lose weight. Based on these data, the American Diabetes Association now Recommends use of SGLT2 inhibitors and GLP-1 receptor agonists before insulin For most patients with type 2 diabetes.
When a young person dies of diabetic ketoacidosis because they have rationed insulin, the culprit is obvious. But when a diabetic patient dies of a heart attack, the absence of an SGLT2 inhibitor or GLP-1 receptor agonist is not to blame, as other explanations abound: his uncontrolled blood pressure, the cholesterol drug he took Didn’t take the cigarette they kept on smoking, bad genes, bad luck. But every year, 1,000 times more Americans die of heart disease with DKA and more of them. 700,000 deathsOf course, a good part are related to diabetes. (The exact number remains unclear.) Diabetes is a major reason why More than half a million Americans depend on dialysis about, and how to manage your end-stage kidney disease 6 million live with congestive heart failure, The figures are clear-SGLT2 inhibitor And GLP-1 receptor agonist It may help to reduce these numbers.
Still, the intake of these life-saving drugs is lingering. only about 10. one of people with type 2 diabetes taking them (still in fewer patients who are not wealthy either White) The main reason is simple and silly: US laws prioritize profits and patents over patients. Because SGLT2 inhibitors and GLP-1 receptor agonists remain under patent protection, drug companies can charge exorbitant rates for: hundreds if not thousands dollars per month, sometimes more than insulin, doctors complete hours hard paperwork In hopes of persuading insurers to help our patients, but we are often denied anyway. And even when we are successful, many patients are still left with painful co-pays and deductibles. The most surprising thing is that despite their substantial upfront cost, these drugs are quite effective cost In the long run because they prevent price complications down the road.
This is where addressing the cost of insulin – and insulin alone – becomes problematic. Doctors are forced daily to decide between the best medicine for our patients and the medicine our patients can afford. Katie Shaw, a primary care physician at Johns Hopkins, where I am a senior resident, told me that many of her patients cannot tolerate SGLT2 inhibitors and GLP-1 receptor agonists. In such cases, Shaw is forced to use older oral alternatives and sometimes insulin. “They’re better than nothing,” she said.
If insulin costs become limited on their own, insulin treatment plans will be more likely to jump to SGLT2 inhibitors and GLP-1 receptor agonists. This would mean more diseases, more disabilities, and more deaths from diabetes.
Medicare patients can avoid some of these effects thanks to IRA. for the provisions in allow medicare Negotiating drug prices And limiting your out-of-pocket spending on prescriptions to $2,000 a year. The law also guarantees price negotiation for a handful of drugs, but SGLT2 inhibitors and GLP-1 receptor agonists are not necessarily on the list. And most Americans are not on Medicare. Already, Shaw said, patients in her practice who are at least able to tolerate SGLT2 inhibitors and GLP-1 receptor agonists are working-class people with private insurance. Some health centers that Shaw and I work at have a . enjoy access to federal drug-exemption program That could make patent-protected drugs, including SGLT2 inhibitors and GLP-1 receptor agonists, more affordable for the uninsured. But most Americans are uninsured not so lucky,
It would be cruel to choose between a world in which more people with type 2 diabetes are pushed to a drug that won’t remove the most dangerous complications, and one in which people with type 1 diabetes are knocked out of life. Instead of setting out-of-pocket spending limits on insulin alone, lawmakers should set their own out-of-pocket spending limits All diabetes medicines. It would protect both insulin-dependent Americans And Smooth SGLT2 inhibitors’ and GLP-1 receptor agonists’ pathways to their revolutionary public-health potential.
The argument for reducing the cost of these drugs for patients is similar to the argument for insulin’s affordability: that making life-saving diabetes drugs affordable is both foolish and inhumane, when their use prevents costly and fatal downstream complications.
Patients like me need affordable access to insulin. But even more so requires access to SGLT2 inhibitors and GLP-1 receptor agonists. If laws stop on insulin, many Americans could die unnecessarily – not from insufficient access to insulin, but from preferential access to it.