MEDICINE

Insulin: 1.3 million Americans with diabetes had limited supplies in the past year, study finds



CNN

In December, Stephanie Arceneaux of Utah will be 30 years old with type 1 diabetes. She was diagnosed at age 6.

“We’ve seen a lot of changes in how we treat diabetes,” she said. “I always thought things would get better as I got older, but unfortunately they didn’t.”

Arceneaux’s husband and young son also have type 1 diabetes. All three of them are dependent on insulin to survive.

“When I first heard about diabetics rationing insulin, my first thought was that I know what it feels like to not have enough insulin in your body, so that’s pretty scary. At the same time, I was like, ‘I’m glad I didn’t do that,'” she said.

“But the more I thought about it, the more I realized I had been doing it all my adult life. I made a choice in my life so that I could take insulin.”

Arceneaux is not alone. In the United States, more than 1 million diabetics had rationed insulin in the past year, according to a study published Monday in the Annals of Internal Medicine.

“The main takeaway is that 1.3 million people in the United States, one of the richest countries in the world, was insulin-dispensed,” said lead author of the study, Breathing of Harvard Medical School and Cambridge Health. says Adam Gaffney, Ph.D., a cardiologist and critical care physician. The Alliance told CNN. “This is a life-saving drug. Insulin rations can have life-threatening consequences.”

Gaffney and his coauthors analyzed the US Centers for Disease Control and Prevention’s 2021 National Health Interview Survey. The study included 982 diabetics using insulin. They investigated how often these people ration insulin because the cost of insulin is high.

People were considered rationing if they answered affirmatively to survey questions about skipping insulin doses, reducing requirements, or deferring insulin purchases.

“What we found is that across the country, about 1.3 million Americans with diabetes are rationed with insulin each year, which is about 16.5% of all people using insulin. ,” Gaffney said.

Some groups said they did it more often, such as those with type 1 diabetes. People without health insurance were rationed most often of all.

Adults under the age of 65 receive rations more often than those over the age of 65, and Gaffney noted that nearly all older, under-rationed people are covered by Medicare.

Two other groups more likely to ration insulin than their counterparts were middle-income individuals and black Americans.

“We’ve seen high rationing of life-saving drugs, which is really concerning for everyone,” Gaffney said.

“We urgently need policy changes to ensure everyone has access to this important medicine without cost barriers,” he said. “And we have to do it today.”

Gaffney and his co-authors found in the study that several factors, including insulin prices in the United States being much higher than elsewhere, and drug companies raising prices “year after year” for their products as well, were contributing to their findings. Underlying the results said..that doesn’t change. ”

“By limiting out-of-pocket insulin payments to $35 per month under Medicare, the 2022 Inflation Reduction Act may improve access to insulin among older adults who experienced substantial rations in our study. “But similar caps for privately insured persons have been removed from the bill, and copay caps do not help the uninsured. It may improve people’s access to insulin.”

According to the CDC, more than 37 million adults in the United States have diabetes, yet 1 in 5 are unaware of it. It is her seventh leading cause of death in the country and the leading cause of kidney failure, lower limb amputation, and blindness in adults.

According to the CDC, the number of adults diagnosed with diabetes has more than doubled in the past year.

Type 1 diabetes is thought to be caused by an autoimmune reaction that stops the body from making insulin.According to the CDC, 5% to 10% of people with diabetes have this type.

Type 2 diabetes means that the body cannot use insulin well to keep blood sugar levels at normal levels. It develops over years and is usually diagnosed in adults.

There is no known way to prevent type 1 diabetes, but type 2 diabetes can be prevented or delayed with healthy lifestyle changes such as weight loss and activity.

The choices Arceneaux made to distribute included not eating (because people need insulin to cover the carbohydrates they eat) and distributing things like the test strips needed to test blood sugar levels. was included. give yourself

She also rationed the other care she needed and spent a lot of time deciding which medical care was more important to her, she said. I got a prescription for it, but didn’t do other things a diabetic should do, like getting an annual eye exam to check for complications like retinopathy.

The cost of insulin “has a huge impact” on her decision-making, she said.

“If you don’t have money to buy it, you don’t have money to buy it,” she said. was to purchase and make available insulin for

When she first moved in by herself, she said, she ran into problems right away. She could afford food and insulin, but not both. I bought some groceries to help out.

“I remember telling her, ‘It’s hard now.’ “And here I am. That was when I was 20. I’m 43 now, almost 44, and it’s even worse now. The cost has skyrocketed.”

She now has insurance through her husband’s employer, but “the cost of premiums is so high that there is little left to cover everything you need.” I have to rely on insulin provided by other members of the community.

The new findings are “very important,” said Dr. Kasia Lipska, an associate professor of medicine at Yale School of Medicine, who sees patients at the Yale Diabetes Center.

“The findings are really concerning in terms of access to insulin for Americans,” said Lipska, who was not involved in the study.

“We have a serious problem: we have a large number of diabetics who are on insulin rations, and there are disparities in access, such as age, race, income, and insurance status,” she said. “I think this study illustrates the problem of access to sustained insulin in our country.”

The findings did not surprise her, she said, but rather corroborate what she had seen clinically. rice field.

“I see people in the hospital who are hospitalized for hyperglycemia and when I ask them what happened they tell me that they either have no insurance or they are underinsured and they have not been able to take their insulin. All right,” Lipska said. “In an outpatient setting, no clinic doesn’t figure out how much insulin costs or how to get patients the insulin they need without breaking the budget. These are like everyday conversations at the Yale Diabetes Center.” is.”

Insulin is “like oxygen” for people with type 1 diabetes, and without it, they can become seriously ill within hours or days with ketoacidosis, a potentially life-threatening complication. You could end up in the hospital. It could even be fatal.

People with type 2 diabetes who don’t have enough insulin can have high blood sugar levels and be at risk for complications such as heart disease, blindness, and kidney failure.

“Diabetes is more expensive now than it was in my 20s,” says Arceneaux. “I know there’s been a study done where he rations insulin to 1 in 4 of her diabetics, but I’m guessing it’s a lot more than that. may just not be aware that it is doing it.

“We’re doing what we need to do to stay alive, which means getting the insulin we need,” she said. “So we may be rationing other things in our lives to do just that, not just insulin.”

Arceneaux, the leader of the Utah chapter of the nonprofit T1 International, says he hears about rationing a lot.

T1 International is led by type 1 diabetics who support their communities, providing the tools they need to access insulin and diabetes supplies.

“We deserve the same quality of life that everyone else receives, and we don’t have to sacrifice a lot of life just to stay alive. Many of us with diabetes don’t.” We make sacrifices every day that others don’t and others don’t realize,” said Arceneaux.

“I think it’s unacceptable and needs to change. And now it needs to change. We’re tired of waiting,” she said. “Diabetics are tired of waiting. We need a true price cap on insulin, and it needs to happen today in order to have everything we need for life.”

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