Just Read: Insulin Access and Affordability Working Group: Conclusions and Recommendations

2018.05 Low Carb and Low Carbon Presentation Slides 410
“The average list price of insulin has skyrocketed in recent years, nearly tripling between 2002 and 2013.” Sources: Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care [Internet]. 2018 May 8;dci180019. Used under license for Non-commercial re-use, Version 1.0, http://www.startribune.com/son-s-death-pushes-mom-into-drug-price-spotlight/482344871/; https://www.flickr.com/photos/taedc/36128835431/; Photograph by Ted Eytan, MD – 07.30.2017 2018.05 Low Carb and Low Carbon Presentation Slides 410 (View on Flickr.com)

Near Tripling of Prices 2002-2013

I read this paper and prepared a few slides relevant to a presentation I am putting together for a meetup I am organizing. As the title states, a working group convened by the American Diabetes Association convened a workgroup to examine the (significant) problem of insulin affordability.

I’ve placed stories next to the data to show the impact of the near tripling of insulin prices since 2003.

A Life or Death Need; Not What Frederick Banting and Charles Best Intended

For more information about the impact, you can follow the #insulin4all hashtag on twitter.

2018.05 Low Carb and Low Carbon Presentation Slides 411
“Sources: Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care [Internet]. 2018 May 8;dci180019. Used under license for Non-commercial re-use, Version 1.0, https://twitter.com/t1international/status/989137704326647808, https://twitter.com/lauramedison/status/930505212917436417 2018.05 Low Carb and Low Carbon Presentation Slides 411 (View on Flickr.com)

This article is a helpful review of the historical origin of our current situation: Why Is There No Generic Insulin? Historical Origins of a Modern Problem | NEJM

When the team (Banting and Best) applied for a U.S. patent in January 1923 (which they later sold to the university for $1), they stated that their goal was not profit, but ensuring the speedy and safe availability of their discovery to the public.Greene JA, Riggs KR. Why Is There No Generic Insulin? Historical Origins of a Modern Problem. N Engl J Med [Internet]. Massachusetts Medical Society; 2015 Mar 19 [cited 2018 May 13];372(12):1171–5.

While the 2017 ADA Workgroup attempted to understand exactly why the price of insulin has gone up so much and multiple solutions are offered, the path to resolution seems a little unsatisfying:

A High Carbohydrate Diet is not the Cause of this Crisis; Low Carbohydrate Diets Will Not Solve It

The paper did not address non-pharmacologic approaches to reducing insulin use. At the same time, the need for insulin is a matter of life and death, regardless of what diet is pursued, with vulnerable populations disproportionately affected:

“For millions of people living with diabetes, including all individuals with type 1 diabetes, access to insulin is literally a matter of life and death. The average list price of insulin has skyrocketed in recent years, nearly tripling between 2002 and 2013. Approximately 7.4 million Americans with diabetes use one or more formulations of insulin. People with diabetes using insulin come from varied economic, racial, and ethnic backgrounds. Almost 20% of African Americans with diabetes use insulin, either alone or with oral medications, as do 14% of Caucasians and 17% of Hispanics with diabetes. Of adults with diabetes earning below the poverty level, approximately 24% use insulin, either alone or with oral medications.” Sources: Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care [Internet]. 2018 May 8;dci180019.

Therefore, the slide below is not intended to criticize patients/humans for having an insulin requirement and/or their dietary choices.

It is a demonstration of some of the causes of insulin resistance in our society today, which is rising dramatically, in places where there should be greater awareness. If anything, the interest in metabolic health, diabetes reversal (for people who are type 2), and diabetes (type 2) prevention, is further spotlighting the problem of insulin affordability for all.

2018.05 Low Carb and Low Carbon Presentation Slides 412
The insulin affordability crisis was not caused by high carbohydrate diets, and it will not be solved by low-carbohydrate diets. It intersects with a significant increase in insulin resistance and related conditions including diabetes type II and non-alcoholic fatty liver disease. 2018.05 Low Carb and Low Carbon Presentation Slides 412 (View on Flickr.com)

An interest in metabolic health brought me to #insulin4all. The video presentation in the tweet below gives an excellent overview.

Citations

  1. Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care [Internet]. 2018 May 8;dci180019. Content above is used under the license for Non-commercial re-use, Version 1.0, of @ADA_Journals
  2. Greene JA, Riggs KR. Why Is There No Generic Insulin? Historical Origins of a Modern Problem. N Engl J Med [Internet]. Massachusetts Medical Society; 2015 Mar 19 [cited 2018 May 13];372(12):1171–5.

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