Essay Example on Management of Diabetes

Introduction

Type 2 diabetes is a condition in which the body produces insufficient insulin or is resistant to the action of insulin. Insulin is an anabolic hormone that promotes the uptake of glucose in the cells, glycogenesis, protein synthesis of skeletal muscle, and lipogenesis. It also plays a critical role in regulating plasma glucose homeostasis by counteracting glucagon and other catabolic hormones. With insufficient insulin, blood sugar increases and thus leading to hyperglycemia which can cause severe complications like damages to kidneys, eyes, extremities, and the nervous system (McEwen, Laura N., et al. 71). The highest risk of mortality due to diabetes is recorded among patients of cardiovascular disease (CVD), hypertension, atherosclerosis, and stroke (CDC, 2005). This essay presents the dilemma associated with the management of diabetes with regards to the extremely high costs of treatment.

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Type 2 Diabetes

About 41 million Americans are prediabetes which implies that they are at the highest risk of diabetes. Between 90 and 95% of them are at risk of Type 2 diabetes. Approximately 25 and 33% of Americans could be diabetic by 2050. Globally, type 2 diabetes is the most prevalent metabolic disorder among the population in both developed and developing countries. All parts of the world are recording alarmingly increasing cases of type 2 diabetes. Among the top risk factors include increased prevalence of obesity (BMI≥30kg/m2) (CDC 2005). Type 2 diabetes is directly associated with high morbidity and mortality which implies substantial personal and societal costs (Yatch et al., 62). According to Church (917), the US, spent about US$132 billion to meet direct and indirect costs of managing diabetes. In 2017, the cost of all diagnosed diabetes in the US was US$327 billion (American Diabetes Association). The cost is used for medical supplies, doctor visit fees, hospital care, and prescription medications with hospital care and prescription medication for inpatients accounting for about 60% of the costs.

Other indirect costs associated with diabetes include depressive and anxiety symptoms exhibited by diabetic patients. Additionally, some diabetic patients lose their jobs or miss job opportunities. Others still incur some costs in terms of reduced man-hour at work and thus lead to monetary losses or compromise on the mental wellbeing of the patient. Nolan, et al (307) for instance established that inability to work due to diabetes disabilities cost US$ 37.5 billion while absents from work accounted for US$ 3.3 billion. Reduced productivity of diabetic employees cost US$ 26.9 billion.

Diabetes Management

A case review of costs of diabetes management in Plainsboro, New Jersey reveals that patients have to part with huge amounts of money or face the dangers of shortcuts; some of which have been fatal. In summary, a patient has to part with $280 per month which is deductible at a rate of $4,000 at the beginning of the year. It implies that not very once a diabetic person can meet the costs but at the same time cannot afford to miss the therapies lest the condition gets out of hand. Effective management of diabetes demands prescription medication which costs about UD$65 per month, cholesterol mediation at UD$50 copay for 90-day (UD$16 per month), high blood pressure medication at a similar rate, insulin at a cost of UD$33 per month, at least one bottle of glucose tablet at about UD$5 per month (a patient needs one to two bottles in one month), Vitamins and other over the counter medication at about UD20 per month, Insulin delivery device at about UD$57, Continuous glucose monitor (CGM) at about UD$41 which is used together with CGM transmitters which goes for about UD$20 per month. Additionally, other supplies such as Blood glucose strips at about UD33, glucose lancets at about UD8$, and miscellaneous supplies at about UD$30 are also needed (Lindberg, 3). Altogether, the costs add up to a huge amount of money which in some cases is far above the monthly income of some people. Some financially incapacitated patients end up rationing some of the suppliers or going for cheaper alternatives that pose more danger to them. Some people have reportedly died from such practices.

The high costs of management translate to ineffective management of diabetes which then leads to suboptimal glycemic control and harmful health consequences among patients. The situation gets even worse in places where resources are poorly allocated or are scarce like in many developing countries. Subsequently, glycaemic targets among diabetic patients are hardly realized due to the high burden of non-adherence of patients to medication and therapeutic inertia among clinicians (Basu, et al., 324). Normally developing countries are characterized by resource-poor settings which then mean limited accessibility of drugs, diagnostics, and physicians' consultation time for patients. Worse still, the standard of care is lacking for existing evidence-based guidelines for the management of diabetes.

Costs of Medication

Some of the explanations given for the high costs of medication include a shift from less expensive pork and beef insulin to genetically engineered human insulin and insulin analogs which are very expensive. There have also been dramatic price increases for insulin in the market along sided drastically changing physicians' prescription practices. Moreover, existing policies limit the payers' ability to negotiate medication prices. Notably, nontransparent negotiations of rebates and discounts have also fueled the extremely high cost of diabetes treatment (Nolan, et al., 307).

In as much as diabetes is a lifestyle disease that is often linked to choices people make in terms of their diet and physical activities, the costs of medication have been somehow punitive. Price setting should be a function of various factors such as policy, cost of production, and economic dynamics among others. There is no question as to whether they could be other alternatives for people living with diabetes. They need the medication and they can't live without the medication. Nevertheless, the medication should not be priced based on the fact that the lives of such people are all about the medication. The government should take the initiative to control the pricing of the medication. For a long time, the government has not directly faced the manufacturers and the distributors of pharmaceuticals on the issues of the cost of some medications. Insurers on the other hand take advantage of the gap to reap maximally from insurance. A strict pricing policy should be established by the national and state government to help people living with diabetes to shoulder the burden of the disease (McEwen, 71). This could help with the standardization of the prices to lower the cost of medication.

Conclusion

In a nutshell, the prevalence of diabetes continues to rise in all parts of the world. The implication of the disease on individuals and the economy cannot be neglected. The US faces a potential case of up to 33% of the country's population suffering from Type 2 diabetes. Unfortunately, the cost of managing diabetes has been drastically increasing and thus posing great threats to many Americans whose incomes are either average or below average. It is therefore important for people to take the initiative to prevent as much diabetes as possible through lifestyle changes focusing on diabetes and physical activity. Equally important is that a universal price control system should be established so that manufacturers of pharmaceuticals do not manipulate prices as they with. The government should immediately come up with a long-lasting strategy of controlling prices. Additionally, the government should initiate the production of the medication without having to rely on private entrepreneurs whose ultimate goal is to maximize profit.

Works Cited

McEwen, Laura N., et al. "Why are diabetes medications so expensive and what can be done to control their cost?" Current diabetes reports 17.9 (2017): 71.

Nolan, J. J., et al. "The cost of treating type 2 diabetes (CODEINE)." Irish medical journal 99.10 (2006): 307-310.

Basu, Saurav, and N. A. N. D. I. N. I. Sharma. "Under-recognised ethical dilemmas of diabetes care in resource-poor settings." Indian J Med Ethics 3.4 (2018): 324-6.

Iqbal, Nayyar. "The burden of type 2 diabetes: strategies to prevent or delay onset." Vascular health and risk management 3.4 (2007): 511.

Yach, Derek, David Stuckler, and Kelly D. Brownell. "Epidemiologic and economic consequences of the global epidemics of obesity and diabetes." Nature medicine 12.1 (2006): 62-66.

Church, Virginia. "Economic costs of diabetes in the US in 2002." Diabetes care 26.3 (2003): 917-932.

Centers for Disease Control and Prevention (CDC). "Diabetes: disabling, deadly, and on the rise." Atlanta (GA): US Department of Health and Human Services (2004).

Lindberg Sara. "Costs of Type 2 Diabetes". Retrieved from
https://www.healthline.com/health/cost-of-diabetes.