The Rising Costs of Treating Type 2 :: Diabetes Self-Management

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Oct 31, 2008

The Rising Costs of Treating Type 2

Tara Dairman

A study published this week in the journal Archives of Internal Medicine has put the spotlight on the rising cost of Type 2 diabetes drugs. According to researchers from the University of Chicago, the University of California, San Francisco, and Stanford University, spending on diabetes drugs increased by 87% between 1994 and 2007, from $6.7 billion to $12.5 billion.

Part of the reason for this increase is that more people are being diagnosed with and treated for Type 2 diabetes. Also, doctors are prescribing more drugs to each person (the average number of drugs prescribed per appointment rose from 1.06 to 1.45 over the course of the study). However, the researchers concluded that "the greatest contributor to increasing costs is the substantially greater use of newer, more costly medications."

The researchers discovered what they called "significant shifts" in the medicines used to treat Type 2 diabetes since 1994. They found that the average cost of a Type 2 diabetes drug prescription was $76 in 2007, compared to $56 in 2001, due in large part to the increased use of thiazolidinediones (rosiglitazone [brand name Avandia] and pioglitazone [Actos]), insulin analogs, sitagliptin (Januvia), and exenatide (Byetta). Unlike the older sulfonylurea drugs and metformin, none of these newer drugs is available in generic form.

These findings are especially interesting in the context of the updated Type 2 diabetes treatment guidelines that were released last week (read more about them here), which recommend using the older, more proven, and less expensive treatments metformin and sulfonylureas before newer, more expensive therapies such pioglitazone and exenatide. The researchers commented that there has been a rise in "off-label" use of thiazolidinediones and exenatide as single, first-line treatments for Type 2 diabetes even though they are approved by the FDA only as add-on treatments to other medications.

In the study's conclusion, the researchers questioned whether the use of more expensive diabetes treatments will result in proportionally improved outcomes. What do you think? Have you had good results with older diabetes drugs? Do you believe that some of the newer therapies are worth the higher cost? Share your thoughts with a comment below.

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Dear Tara.

I found that using the long lasting insulin "Lantus" to be much easier and possibly even less expensive overall, when you include less BG testing than the when using the older NPH that was really tricky to use.

Posted by: CalgaryDiabetic | Oct 31, 2008 04:47 PM

The first drug my doctor prescribed after diagnosis was Metformin. Then as my type 2 disease progressed he tried some of the newer medicines like Precose which did not work for me. Then he had no other choice except insulin injections. At first I wasn't very excited about multiple injections, but when I saw that it allowed me to have much better control, I figured that it was worth the cost and the effort. I am currently on Lantus and Humalog. My endocrinologist recently added Symlin to see if I can get even better after meal control. Symlin may well be a good drug for me however it is extremely expensive. I don't know how long I will be able to stay on it because of the cost.

Posted by: Mayumi | Nov 01, 2008 10:30 AM

Dear Mayumi. Does the Symlin help you to keep your weight down?

Posted by: CalgaryDiabetic | Nov 03, 2008 07:41 PM

While I am sure that some of the newer type drugs are beneficial to some; bringing their glucose readings into control, I am a firm believer that as a patient or person with the disease you also have to take control. You need to do everything in your power to watch your diet and get off that couch and move.

I was diagnosed 4 years ago and have managed to keep my A1c in the 5.5 range for the entire four years. Daily monitoring is essential, watching your diet is as simple as adding more fruits and veggies and getting off the sofa has not been a problem. I even travelled on a 9 day cruise without gaining weight. Walking on the ship and sticking to fruits, veggies and small portions of meat all added to my success

Posted by: nancy | Nov 05, 2008 05:11 PM

I was diagnosed with Type 11 30 or more years ago. I progressed from treatment with oral meds. to insulin 70/30 in 1993, then to Lantus in late 2007.

However, I found a doctor who was aggressive in the treatment of diabetes and he was able to get approval for an insulin pump for me. I am so indebted to him. The consistent Basal of quick acting insulin and the ability to control the carb. intake to the pump's capability to give me the proper amount of insulin for that Bolus has made my life, well actually, liveable.

I love my pump and I would recommend it to anyone who has difficulty with after meal highs, and unexpected lows.

There is a Sensor which can be used in conjunction with the meter which eliminates so much testing also. Just thought I would mention it as it gives a constant reading of the BG.

Posted by: conhon | Nov 05, 2008 09:57 PM

I started off with metforman and slowly added
gylburide, actos and byetta. I had a problem with metformin and was taken off and continued on the other drugs which didn't help. I now take lantus and novolog and my blood sugars have improved.

I wish I would have taken insulin from the beginning because my diabetes would have been under better control.

Posted by: ladybromel | Nov 05, 2008 10:14 PM

I found that while I needed medication, Lantus worked great and was not that expensive. I had been on Lantus for 6 months. The insulin did its job and brought my sugar under control while I exercised and dieted. It was alot of work but now I am off all medications and feel great. Thank you Lantus

I would go back on insulin if needed before I would take an oral medication. Insulin did not cover up the problem. It gave me the energy I needed until I could fix the problem on my own.

Posted by: Robert | Nov 05, 2008 11:47 PM

When I was first diagnosed my doctor prescribed Metformin but I had severe stomach pains so she switched me to Actos and then Avandia, but because of the side effects I did not want to continue with those drugs. She put me back on Metformin and I have had good results with the second time around. I have been using it for at least one or two years now and have been able to keep my diabetes under control with a good A1c.

Posted by: Virginia | Nov 06, 2008 12:30 AM

Tara,
My diabetes support group at the local senior center has been following the development and testing of a Metformin chewing gum and the liquid insulin, Oral-lyn, that is sprayed in the mouth and absorbed by the cheeck cells.
How about doing a story sometime on these two new drugs as they seem to have great potential for seniors who are afraid of taking insulin injections. When will they be available, how well do they work, and will they be affordable?

Posted by: Florian | Nov 06, 2008 08:51 AM

I received an ad from a Canadian company saying that they could supply a generic form of Actos made in India. Is this true and is it not available here because the drug manufacturers have it blocked. Can you verify this?

Posted by: rmccon214 | Nov 06, 2008 10:50 AM

I was diagnosed with Type 2 in January 2003. At that time Glucotrol was prescribed. It was OK but then my weight started increasing and so earlier this year my doctor changed to Metformin and Glyburide. I have been doing great! My A1C s have all been very low (5 or better) My weight is going down. Like Nancy, I went on a cruise vacation and did not gain one pound. I also make a concerted effort to exercise every day. I eat a lot of vegetables and fruits and have lowered my meat intake. Although I know I need the meds, I think that watching what I eat and getting plenty of exercise is what is really helping me. Emmy

Posted by: Emmy | Nov 06, 2008 11:49 AM

rmccon214, we can't verify any claims made by this company. Here's an excerpt from the FDA's Web page on importing drugs:

"Many drugs sold in foreign countries as "foreign versions" of approved prescription drugs sold in the United States are often of unknown quality with inadequate directions for use and may pose a risk to the patient's health. ...Since FDA cannot assure the consumer that the drug purchased in the foreign country would be the same product his or her physician's prescription is written for, we recommend the product covered by the prescription be acquired in the United States."

You can read the full document at www.fda.gov/ora/import/pipinfo.htm.

Posted by: Tara Dairman, Web Editor | Nov 06, 2008 12:07 PM

I use Metformin XR as my main treatment, with reasonably good results. I've triedACTOS with Metformin & had severe adverse side effects. I did a bit of research on glitazones, and consider myself luckey, they could have been much worse. I wouldn't wish glitazones on my worst enemy. They should be ordered off the market. I have a tendency to have an excessive after meal rise; I take Prandin to control this. I also take Januvia; the original intent was to improve glucose control further, but it has proved to have only minor benefits for glucose control. I take it mainly for its side effects, it has successfully treated urinary and GI problems that my doctors were unable to find cause or treatment for. DPP-4 inhibitors have not been fully researched. DPP-4 is used by other systems. Taking a DPP-4 inhhibitor like Januvia effects the immune system, urinary system, GI System, and other body systems in ways that have not been studied. There is serious concern about this. So far, so good.

Posted by: javanwyk | Nov 06, 2008 11:47 PM

I have been on glyburide/metformin 2.5/500 for a while now. It was not doing to well to control my sugar. My doctor added Avandia 4mg tablets to the meds. I take one Avandia and two glyburide/metformin in the morning and one glyb/met in the afternoon. Now my a1c is down to 6.7%. the avandia has helped out alot. Either one alone does not work that well but both together works very well.

Posted by: robin | Nov 09, 2008 11:11 PM

i have been diagnosed as a Type 2 diabetic for almost 25 years. Originally, I was in denial, but after i accepted the fact, i responded with the solutions of the day, diet, early drug therapy, life style. None were done with much purpose or enthusiasm. Then, after i was put on insulin, I began taking the newer drugs, including byetta. It was mucheasier, more successful and required less input and effort.
Now, i think the old ways, although requiring more self effort and commitment, are more beneficial. Exercise, which really takes discipline, is the best of all, followed by diet control, and then, drugs, as a secondary compliment to the first two.
Uunfortunately, because of my age and deteriorated physical condition (diabetic neuropathy), the workouts are no longer effective.
My conclusion is that the quick and easy route to treatment is not the most effective and long lasting one.

Posted by: Tom Hull | Nov 10, 2008 02:21 PM

Dear Rmccon214.

My wife remembers reading in Consumers Report that the Company that you got the add from could be an Indian Company pretending to be a Canadian one. Canadian drugs are up to american standards others you wonder.

Posted by: CalgaryDiabetic | Nov 14, 2008 03:03 PM

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