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Jane, a 50-year-old woman with Type 2 diabetes, comes into a medical office for a checkup. She mentions that she has been without health insurance for about five years and hasn’t seen a doctor. The red flags go up. There is concern regarding the patient and her diabetes management and lab tests are ordered.

What are the current challenges facing diabetics with respect to medication management?

Diabetes is a widely prevalent chronic disease which affects more than 400 million people throughout the world. In the United States, approximately 9% of adults have been diagnosed with Type 2 diabetes. There has been an increase in the incidence of diabetes over the past several decades as a result of the obesity epidemic in both adults and children.

Diabetes causes a multitude of medical complications, most prominently cardiovascular disease, kidney disease, blindness and amputations. Those complications directly correlate with the degree to which a person’s diabetes is well controlled. Following a healthy diet and engaging in a consistent exercise routine are important components of a diabetes treatment plan along with medication management.

The discovery of insulin in 1921 by Sir Frederick Banting saved lives and revoked a death sentence for those suffering with diabetes. Banting refused to apply for a patent for his discovery because he wanted insulin to be available to everyone. In one of medicine’s most dramatic moments, Banting went from bed to bed injecting children with insulin who were dying from diabetes and each one recovered from their diabetic coma and returned home to their grateful families.

For those afflicted with diabetes today, it is widely recognized that the high cost of diabetic medication creates tremendous challenges for people. It is estimated that the annual cost of diabetic medications in the United States is approximately $60 billion per year.

On an individual level, the financial burden can have a tremendous impact on people who have no health insurance or have high deductibles and high out-of-pocket costs. Some national health care surveys have shown that many diabetics do not take their medications as prescribed, in order to lower their costs. A common technique diabetics employ is to ration their medications, which can have a negative effect on their blood sugar levels. The average price of insulin which was estimated to be $234 per month in 2012, increased to about $450 per month in 2016.

There have been multiple Congressional and government inquiries focusing on making the price of insulin and other diabetic medications more affordable so that patients will not have to forgo these potentially life-saving treatments. In recent years, some health insurers have offered more affordable insulin options, possibly due to government and public pressure. One bright light in this environment of high drug costs, is the giant retailer, Walmart. It is providing a tremendous service to people with diabetes, by offering certain types of over-the-counter insulin at $25 per vial, which is a big cost savings.

Jane, I’m happy to report, got the results of her exam which showed excellent control of her blood sugar levels. How was she able to accomplish this without health insurance for many years? Her diligence and responsible self-care behavior of taking two insulin injections daily for a number of years and the insulin she purchased from Walmart that was within her budget.

Dr. Mark Roth writes about internal medicine for the Cleveland Jewish News. He is an internal medicine physician with University Hospitals in Cleveland.

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