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Diabetes: Drugs, Diet and Data

http://flickr.com/photos/chicagolau/2437288655/Picnic season is upon us – a time for cookouts and gatherings around the grill or at the park. This means burgers and hot dogs, potato salad and chips, ice cream and lemonade. This means we’ll be tempted to pack on pounds even as we’re trying to cram ourselves into shorts and bikinis.

For those Americans with diabetes, all the starch and sugar that come with summertime meals and outings are a serious hazard not just for their waistline but also for their health.

Type 2 diabetes is the most common form of diabetes (90% of all cases of diabetes), and more than 20 million Americans have it. The latest analysis shows another 54 million Americans at risk for Type 2 diabetes (pre-diabetes), which is linked to being overweight and out of shape. As obesity reaches epidemic proportions in the U.S., the number of middle-aged Americans with Type 2 diabetes has doubled in the last 30 years. Type 1 diabetes is an auto-immune disease and not related to obesity.

Yet what’s rising even faster than the need for these drugs is the spending on them, making these medicines the biggest driver in spending on pharmaceuticals. Use of diabetes drugs increased only 2.3% last year, but spending rose 12%.

Why is spending rising for a drug used to treat 1 health problem often caused by obesity while spending on drugs for other obesity-related health problems – like cholesterol-lowering drugs – are decreasing even as their use is growing?

  • Use of lipid-lowering drugs, like statins, actually grew much faster than use of diabetes drugs last year (5.9% versus 2.3%).
  • These anti-cholesterol drugs account for a higher proportion of medical plan prescription costs than do diabetes drugs (10.8% vs. 7.0%).
  • But spending on these cholesterol-lowering drugs fell 8.5% last year because 2 big statins, Merck’s Zocor and Bristol-Myers Squibb’s Pravachol, went generic (and thus much cheaper) in 2006, and insurers are pushing patients on a third, Pfizer’s Lipitor, to switch to generics.

The answer is that the most popular diabetes drugs are newer and thus still protected by patent. Drugs that are still under patent, as opposed to generic, are subject to manufacturer price inflation and are protected by laws that limit imitation and competition, making them more expensive overall.

Fortunately, a new study has revealed that diet and exercise can reduce the occurrence of Type 2 diabetes by about 43% over 20 years.

It will be interesting to see what happens to diabetes drug spending in 2008.

  • Will there be any long-term fallout from the November 2007 FDA decision to give the popular GlaxoSmithKline diabetes drug Avandia a black box warning for heart attack risks (its second)? Will its competitor Actos continue to pick up the slack from Avandia’s falloff?
  • How quickly will the study’s results on the effectiveness of diet and exercise be integrated into diabetes care? Should we be concerned that at least one other study found similar results – 6 years ago – and yet this recent study is treated as, well, news?

Meanwhile, San Antonio, Texas, has put in place an 18-month pilot program that will track 50,000 residents with diabetes to determine how to improve their care. Because the city has the second highest diabetes death rate (just ahead of New Orleans among the 54 largest U.S. cities), local officials are anxious to limit the disease and its cost. A computer program will collect data on blood tests and map the results into health care provider scores. The new technology will also generate patient health reports with accompanying recommendations for care.

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