When I heard my patient was back in the ICU, my heart sank. But I wasn’t surprised. Her paycheck usually runs out at the end of the month, so insulin is short, too. As she stretches her supply, her blood sugar rises. Soon followed by insatiable thirst and constant urination. Once keto acids build up, stomach aches and vomiting begin. She always managed to get to the hospital before the damage reached her brain and heart. But we both worry that one day she won’t.
The Inflation Cut Act, passed last month, aims to help people like her by lowering the cost of insulin across America. Although efforts to extend protection to privately insured Americans have been Banned in the SenateDemocrats have succeeded in capping Medicare drug spending by $35 a month Meaningful savings for seniorsSome of them will save hundreds of dollars per month thanks to this procedure. In theory, the policy (and similar Of which at the state level) will help the estimator 25% of Americans take insulin who were forced to legalize medication because of the cost, and will prevent some 600 American deaths annually of diabetic ketoacidosis, the fate I am trying to save my patient from.
Indeed, the laws defining the co-reimbursement of insulin are equally welcome news financially And the medically For patients who depend on medication for survival. However, in their current version, these laws may backfire, leading to more diabetes-related deaths overall.
How can this be true? Thanks to the development of new drugs, the role of insulin in treating diabetes has declined over the past decade. It remains necessary for a small percentage of type 1 diabetics, including my patient. but for 90% of Americans have type 2 diabetesIt should not be routine First, second or even third line treatment. The reasons for this are many: Of all the diabetes medications, insulin carries the highest risk It causes dangerously low blood sugar. The most common medication comes in the form of an injection, so giving it usually means painful acupuncture. All this effort is rewarded with (usually undesirable) overweight. Above all and finally, although insulin is excellent at curbing high blood sugar – the hallmark of diabetes and The driver has some complicationsIt is not as impressive as other drugs in relieving the most deadly and debilitating consequences of disease: heart attacks, kidney disease, and heart failure.
Large clinical trials have shown that there are two new classes of diabetes drugs, SGLT2 inhibitors and GLP-1 receptor antagonists, outperforms the alternatives (including insulin) in reducing the risk of these disabling or fatal outcomes. Giving patients these drugs instead of the old options over three years It is forbiddenin the middle, One death for every 100 treatments. Also, SGLT2 inhibitors and GLP-1 receptor agonists pose a lower risk of causing dangerously low blood sugar, generally do not require frequent injections, and help patients lose weight. Based on this data, the American Diabetes Association is now Recommends the 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 due to insulin rationing, the culprit is clear. But when a diabetic patient dies of a heart attack, a lack of an SGLT2 inhibitor or a GLP-1 receptor agonist isn’t to blame, because other explanations abound: uncontrolled blood pressure, cholesterol medications they didn’t take, cigarettes they kept smoking, bad genes , bad luck. But every year, 1,000 times more Americans die of heart disease than DKA, and among those 700,000 deathsA large part is linked to diabetes. (The exact number is still a mystery.) Diabetes is a major cause of this More than half a million Americans depend on dialysis To manage end-stage kidney disease, that’s approx 6 million live with congestive heart failure. clear data –SGLT2 . inhibitors And the GLP-1 receptor agonists It can help reduce these numbers.
However, it is still slow to take these life-saving drugs. just around one in 10 People with type 2 diabetes take it (lower number among patients who are not rich or white). The main reason is simple and stupid: 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 them: hundreds if not in thousands of dollars a month, Sometimes more than insulin. Doctors spend hours completing hard leaves Hoping to convince insurance companies to help our patients, but we often refuse anyway. And even when we succeed, many patients are left with painful co-payments and deductibles. The craziest part is that despite their large upfront expenses, these drugs are totally fine Cost-effective In the long run it prevents expensive complications in the future.
This is where addressing the cost of insulin – and insulin only – becomes a problem. Doctors are forced every day to choose between the best medicine for our patients and the ones that our patients can afford. Katie Shaw, a primary care physician with an active practice at Johns Hopkins, where I’m a senior resident, tells me that many of her patients can’t afford SGLT2 inhibitors and GLP-1 receptor antagonists. In such cases, Shaw is forced to use old oral alternatives and sometimes insulin. “They’re better than absolutely nothing,” she said.
If the cost of insulin is determined on its own, insulin will likely jump ahead of SGLT2 inhibitors and GLP-1 receptor agonists in treatment plans. This means more diseases, more disabilities, and more deaths from diabetes.
Medicare patients may avoid some of these effects thanks to For provisions in the IRA Allow Medicare Negotiating drug prices Covering personal prescription expenditures of $2,000 annually. The law also warrants price negotiations for a handful of drugs, but SGLT2 inhibitors and GLP-1 receptor agonists won’t necessarily be on the list. Most Americans are not on Medicare. Shaw said the patients in her clinic who tend to be the least able to afford SGLT2 inhibitors and GLP-1 receptor antagonists are already working class and have private insurance. Some health centers, including the one where Shaw and I work, have access to Federal Drug Reduction Program That could make patented drugs, including SGLT2 inhibitors and GLP-1 receptor agonists, more affordable for the uninsured. But most Americans are without insurance They are not so lucky.
It would be cruel to choose between a world in which more people with type 2 diabetes are pushed toward a drug that does not prevent the most serious complications, and a world in which people with type 1 diabetes are neglected. Instead of capping the petty cash of fair insulin, legislators should end the petty cash of All diabetes medications. This will protect insulin-dependent Americans And the The smooth path of SGLT2 inhibitors and GLP-1 receptor agonists to revolutionary public health potential.
The argument for lowering the cost of these drugs for patients is the same as that of insulin’s affordability: it is foolish and inhuman to make life-saving diabetes drugs unaffordable when their use prevents expensive and fatal complications.
Patients like me need access to affordable insulin. But more than that it needs access to SGLT2 inhibitors and GLP-1 receptor agonists. If the laws stopped on insulin, many Americans could die needlessly — not from not getting enough insulin, but from preferential access to it.