Spiking deaths, health crises, and amputations: Diabetes is ‘out of control’

diabetesreuterrise-300x120More than 100,000 people in this country died last year due to diabetes. That’s 17% more than the year before. And in younger age groups, it’s even worse: deaths from diabetes climbed 29% last year  among those ages 25-44, federal data show.

The figures should raise huge alarms that diabetes, as exposed by the coronavirus pandemic, is “out of control,” reported Chad Terhune, Robin Respaut, and Deborah J. Nelson for Reuters news service.

Their investigation, including an analysis of federal data to draw a depressing depiction of diabetes’ significant damages to the health of millions of Americans, found that the pandemic only begins to show huge failures in the care of what should be a manageable illness:

“This grim toll [of 100,000+ plus diabetes deaths in 2020] is the result of a public-health failure that long predates the pandemic — and that is almost certain to persist after Covid-19 abates. After years of advances in treating diabetes, progress stalled about a decade ago. Since then, despite billions of dollars spent on new treatments, the prognosis for people with diabetes has been getting worse as the number of patients with the disease has increased, especially among working-age and even younger people …

“Late in the last century and early in this one, medical breakthroughs steadily chipped away at rates of diabetes-related deaths and complications in the United States. But the trend reversed as rising obesity and its consequences — like diabetes, hypertension, and cardiovascular disease — more than offset improved therapies.

“From 2009 to 2015, data [from the federal Centers for Disease Control and Prevention] show that among diabetes patients, rates of hospitalization for hyperglycemic crises soared by 73%, and deaths by 55%. From 2010 to 2015, a jump in the rate of lower-limb amputations — always a risk for diabetes patients — erased more than one-third of a 20-year decline. The sharpest increases in these numbers were among adults 44 and younger. A Reuters analysis of more recent state-level data found that the trend has persisted. By 2019, U.S. deaths attributed primarily to diabetes reached their highest rate in eight years. So, when the pandemic struck, Americans with diabetes were in poorer health than they had been in years, increasing their vulnerability just as the virus overwhelmed the U.S. health care system. ‘It didn’t have to be this bad,’ said Dr. Robert Pearl, a Stanford Medical School professor and former chief executive of the Kaiser Permanente Medical Group. ‘If we had spent more time and effort toward preventing and better managing diabetes, thousands of patients wouldn’t have needed hospitalization in the first place,’ Pearl said. ‘And many of them would still be alive.’”

The Reuters’ investigation points to multiple culprits for escalating harms attributable to diabetes:

“The reasons for the worsening outlook for diabetes patients are rooted in the American lifestyle and medical system. More Americans are developing diabetes earlier, even in childhood, because of long-term societal shifts toward sedentary lifestyles and unhealthy diets, according to researchers and doctors. Younger patients often have a harder time managing their disease, develop complications faster, and tend to have less consistent access to medical care, doctors say. Some patients ration their medications and limit doctor visits to avoid the hefty out-of-pocket costs of increasingly common high-deductible insurance plans, backed for years by employers, insurers, and policy makers. The focus in U.S. health care on treating crises over preventing them doesn’t help, downplaying the importance of lifestyle changes that could lessen the severity of the disease.”

(A graphic accompanying the Reuters investigation reported that diabetes affects at least two regions of the country in greater fashion — Appalachia and the Southeastern U.S. — especially due to poor diet, dubious food supplies, and unhealthy lifestyles.)

Big Pharma has raked in big profits on diabetes care, with skyrocketing prescription drug costs, the news service reported:

“Diabetes has become a cash cow for the drug industry. Annual sales of insulin and other diabetes drugs surpassed $75 billion in 2020, according to the IQVIA Institute for Human Data Science. That’s up from $24 billion in 2011 and second in total revenue only to drugs for inflammatory conditions such as rheumatoid arthritis. But a Johns Hopkins University study published in the New England Journal of Medicine in June that tracked more than 6,000 type 2 patients from 1999 through 2018 found that the drugs weren’t getting to many patients who needed them, especially younger patients and those without insurance. Nearly 20% of patients between the ages 20 to 44 with raised A1c [blood sugar] levels took no glucose-lowering drugs, compared to 10% of those 45 and older, said Dr. Elizabeth Selvin, who co-authored the study. The gap was even more pronounced between insured and uninsured patients of all ages. The newer drugs can reduce the risk of heart disease and promote weight loss, but ‘they are very expensive and many of the patients that really need them … are not covered,’ said Dr Nestoras Mathioudakis, co-medical director of the Baltimore Metropolitan Diabetes Regional Partnership at Johns Hopkins.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care, especially as they grapple with skyrocketing prices for prescription medications — too many of which turn out to be dangerous drugs.

Diabetes has been a worsening disease for some time now. Still, politicians and regulators somehow have managed to turn a blind eye to Big Pharma’s profiteering and legal gamesmanship with medications to deal with the condition, notably insulin. Here is a slice of a January position paper by a medical specialists group (endocrinologists), denouncing insulin’s inexplicably soaring costs and the damage this causes to patients:

“The true cost of insulin can be difficult to pinpoint because of a lack of transparency in financial agreements between stakeholders in the supply chain, geographical differences in cost, and insurance coverage. Novolog, a commonly used insulin, has been available since 2001. While this product has been unchanged, its price increased by 353% over a 15-year period between 2001 and 2016 and it continues to rise. Humulin U500 has increased from $170 to more than $1400 since 1987. From 2001 to 2019, the price of Humalog increased 1200% for a vial of insulin.”

The obstacles that patients confront in trying to control their diabetes end up costing us all, the doctors’ group noted:

“One study indicates that improved adherence among people with diabetes could prevent nearly 700,000 emergency department visits, 34,100 hospitalizations, and save $4.7 billion annually.”

The Biden Administration has started to tackle the nightmare of soaring prescription drug prices, including insulin. But it is clear we have much work to do in this area, and, as well, in better controlling the major health problems attributable to diabetes.

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