Diabetes Access

Poverty, Poor Diabetes Management Go Hand-in-hand: Study

Poverty, poor diabetes management go hand-in-hand: study By Steven Ross Johnson |December 30, 2014 People who have difficulty paying for food and medications are associated with a higher likelihood of having poorer control over their diabetes , according to a new study examining the relationship between nonmedical determinants and health outcomes. About 39% of patients studied reported to have at least one material need, such as food insecurity, unstable housing and underuse of medications due to cost, according to the study published Monday in JAMA Internal Medicine . Researchers found such social determinants were associated with poorer management of diabetes and an increased number of outpatient visits, hospitalizations and trips to the emergency department. Healthcare systems are increasingly accountable for health outcomes that have roots outside of clinical care, the study concluded. Because of this development, strategies that increase access to healthcare resources might reasonably be coupled with those that address social determinants of health, including material need insecurities. In particular, food insecurity and cost-related medication underuse may be promising targets for real-world management of diabetes mellitus. Data was collected from a random group of 411 patients from the Boston area with Type 2 diabetes from June 2012 through October 2013. Roughly 46% of those studied were found to have poor diabetes control despite only 4% being uninsured and 3% having no coverage for prescriptions. Roughly 19% of patients reported having food insecurity, while 28% reported underusing medications because of cost. A little more than 10% reported having unstable housing and 14% had issues paying their utility bills. So, having increased access to healthcare service Continue reading >>

Patient Access To Research

This research confirms that the presence of elevated FABP4 during pregnancy can predict pre-eclampsia in women with type 1 diabetes and suggests it may be an important biomarker for use in screening. Be Nicer to Yourself, and Your A1C Will Thank You: Self-Compassion, Depression, and Diabetes This study suggests that learning to be kinder to oneself (rather than being harshly self-critical) may have both emotional and metabolic benefits among patients with diabetes. The ability to be kind and to understand oneself in the face of difficult feelings may be important for reducing the suffering linked to depression and distress and for improving A1Cthe key clinical marker of effective diabetes management. The benefits of developing self-compassion might also extend to other chronically ill populations. Sniffing Out Hypoglycemia: How Dogs Can Detect Low Blood Glucose Levels These findings suggest that detection of a chemical in the breath called isoprene may offer an easy alternative to monitoring changes in blood glucose levels for people with diabetes. This also likely explains how dogs can detect (and can be trained to detect) low blood glucose levels in their owners. Bariatric Surgery Beats Diet and Exercise in a Head-to-Head Comparison According to the findings of this study, compared with aggressive diet and exercise, RYGB surgery results in greater weight loss, leads to type 2 diabetes remission more often, and offers tighter blood glucose control, in addition to improvements in other risk factors for heart disease, in patients who are mild-to-moderately obese. According to these findings, type 2 diabetes is a potentially reversible condition. An intense weight loss program was able to eliminate diabetes in participants for at least 6 months. This study suggests that Continue reading >>

Diabetes Patients New Challenge: Non-medical Switching

Diabetes Patients New Challenge: Non-Medical Switching Managing diabetes is an all-day, every-day task for millions of Americans, explains a new video from the Diabetes Policy Collaborative . But just when patients have an established regimen regularly checking blood sugar, injecting insulin, exercising and eating right their health plan can introduce new complications through non-medical switching. The Diabetes Policy Collaborative, an advocacy group that focuses on access to medical care and treatment, sees this as a real problem for patients. Non-medical switching is an umbrella term for techniques that push stable patients to medications that are less costly for the health plan. The health insurer may exclude a specific insulin or medication from its formulary of approved drugs, or switch the drug to a coverage tier that requires higher out-of-pocket costs, pricing patients out of access. For some patients, the switch has no meaningful effect. But others are not so lucky. I personally know patients whove had boils appear at the site of insulin injection, explained Stewart Perry of the National Diabetes Volunteer Leadership Council, referring to an incident depicted in the video, or really struggled to get their blood sugar back in range. Perry is also former chairman of the American Diabetes Associations national board of directors. The video argues that non-medical switching disrupts the delicate balance of therapies and lifestyle choices that allows each patient to manage diabetes. Now, as the video notes, some state policymakers are stepping in. Several states have considered legislation that would provide stable patients continued coverage for drugs that treat chronic conditions. This legislation could help people with diabetes maintain their regular treatment, Continue reading >>

Diabetes Access Support

FARXIGA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2017. Data on File, REF-8609, AstraZeneca Pharmaceuticals LP. Nauck MA, Del Prato S, Meier JJ, et al. Dapagliflozin versus glipizide as add-on therapy in patients with type 2 diabetes who have inadequate glycemic control with metformin: a randomized, 52-week, double-blind, active-controlled noninferiority trial. Diabetes Care. 2011;34(9):2015-2022. FARXIGA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2017. FARXIGA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2017. Wong ND, Patao C, Wong K, Malik S, Franklin SS, Iloeje U. Trends in control of cardiovascular risk factors among US adults with type 2 diabetes from 1999 to 2010: comparison by prevalent cardiovascular disease status. Diab Vasc Dis Res. 2013;10(6):505-513. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of diabetes and its burden in the United States, 2014. Accessed September 28, 2015. Centers for Disease Control and Prevention. Age-adjusted percentage of adults aged 18 years or older with diagnosed diabetes who were overweight, United States, 19942010. Accessed September 18, 2015. FARXIGA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2017. FARXIGA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2017. Henry RR, Murray AV, Marmolejo MH, Hennicken D, Ptaszynska A, List JF. Dapagliflozin, metformin XR, or both: initial pharmacotherapy for type 2 diabetes, a randomised controlled trial. Int J Clin Pract. 2012;66(5):446-456. FARXIGA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2017. Henry RR, Murray AV, Marmolejo MH, Hennicken D, Ptaszynska A, List JF. Dapagliflozin, metformin XR, or both: initial ph Continue reading >>

Access To Health Care And Control Of Abcs Of Diabetes

Access to Health Care and Control of ABCs of Diabetes Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Corresponding author: Xuanping Zhang, [email protected] . Received 2012 Jan 13; Accepted 2012 Feb 24. Copyright 2012 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. To examine the relationship between access to health care and diabetes control. Using data from the National Health and Nutrition Examination Survey, 19992008, we identified 1,221 U.S. adults (age 1864 years) with self-reported diabetes. Access was measured by current health insurance coverage, number of times health care was received over the past year, and routine place to go for health care. Diabetes control measures included the proportion of people with A1C >9%, blood pressure 140/90 mmHg, and non-HDL cholesterol 130 mg/dL. An estimated 16.0% of known diabetic adults were uninsured. Diabetes control profiles were worse among uninsured than among insured persons (A1C >9% [34.1 vs. 16.5%, P = 0.002], blood pressure 140/90 mmHg [31.8 vs. 22.8%, P < 0.05], and non-HDL cholesterol 130 mg/dL [67.1 vs. 65.4%, P = 0.7]). Compared with insured persons, uninsured persons were more likely to have A1C >9% (multivariate-adjusted odds ratio 2.4 [95% CI 1.24.7]). Compared with those who reported four or more health care visits in the past year, those who reported no health care visits were more likely to have A1C >9% (5.5 [1.226.3]) and blood pressure 140/90 mmHg (1.9 [1.13.4]). In people with diabetes, lack of Continue reading >>

Diabetes Access Support

Prior serious hypersensitivity reaction to dapagliflozin or saxagliptin QTERN is contraindicated in moderate... Read More Prior serious hypersensitivity reaction to dapagliflozin or saxagliptin QTERN is contraindicated in moderate to severe renal impairment (eGFR <45 mL/min/1.73 m2), end-stage renal disease, or patients on dialysis FARXIGA is contraindicated in severe renal impairment (eGFR <30 mL/min/1.73 m2), end-stage renal disease, or patients on dialysis Pancreatitis: There have been postmarketing reports of acute pancreatitis in patients taking saxagliptin and in the SAVOR cardiovascular outcomes trial. Observe for pancreatitis. If pancreatitis is suspected, discontinue QTERN Heart Failure: In the SAVOR cardiovascular outcomes trial, more patients treated with saxagliptin were hospitalized for heart failure compared to placebo. Patients with a prior history of heart failure or renal impairment had a higher risk for hospitalization for heart failure. Consider the risks and benefits of QTERN in patients who have known risk factors for heart failure. Monitor for signs and symptoms. If heart failure develops, consider discontinuation of QTERN Hypotension: Dapagliflozin causes intravascular volume contraction and symptomatic hypotension can occur. Assess and correct volume status before initiating QTERN or FARXIGA in patients with impaired renal function, elderly patients, or patients on loop diuretics. Do not initiate in patients with an eGFR <60 mL/min/1.73 m2. Monitor for hypotension Ketoacidosis has been reported in patients with type 1 and type 2 diabetes receiving dapagliflozin. Some cases were fatal. Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis regardless of blood glucose level. If suspected, discontinue QTERN or FA Continue reading >>

Diabetes Technology Moves Closer To Making Life Easier For Patients

For people with diabetes, keeping blood sugar levels in a normal range – not too high or too low – is a lifelong challenge. New technologies to ease the burden are emerging rapidly, but insurance reimbursement challenges, supply shortages, and shifting competition make it tough for patients to access them quickly. One new product is a fast-acting insulin from Novo Nordisk. It is designed to help to minimize the high blood sugar spikes that often occur when people with diabetes eat a meal containing carbohydrates. This new formulation, branded "Fiasp," adds niacinamide (vitamin B3), which roughly doubles the speed of initial insulin absorption compared to current fast-acting insulins taken at mealtime. This new insulin hits the bloodstream in under three minutes. Another advance is Abbott's new monitoring device called the FreeStyle Libre Flash. It's new in the U.S. but has been available in Europe since 2014. It's a round patch with a catheter that is inserted on the arm for up to 10 days and a durable scanning device that the user waves over the patch to read the level of sugar in their tissues, which reflects the blood sugar level. The Libre works a bit differently than the two currently available continuous glucose monitors (CGMs) made by Dexcom and Medtronic. The Libre doesn't require users to prick their fingers for blood tests to calibrate it, whereas users of the other monitors must perform twice-daily fingerstick calibrations. Also, the Libre is approved for longer wear – 10 days (14 in Europe) versus seven days for the two current CGMs. And, it is likely to be considerably less expensive, although Abbott isn't providing cost information for the U.S. just yet. In Europe, the Libre system costs about four Euros a day (about $4.70). But, unlike the current d Continue reading >>

The Missed Patient With Diabetes: How Access To Health Care Affects The Detection Of Diabetes.

The missed patient with diabetes: how access to health care affects the detection of diabetes. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Xuanping Zhang, [email protected] Diabetes Care. 2008 Sep;31(9):1748-53. doi: 10.2337/dc08-0572. OBJECTIVE: This study examined the association between access to health care and three classifications of diabetes status: diagnosed, undiagnosed, and no diabetes. RESEARCH DESIGN AND METHODS: Using data from the 1999-2004 National Health and Nutrition Examination Survey, we identified 110 "missed patients" (fasting plasma glucose >125 mg/dl but without diagnoses of diabetes), 704 patients with diagnosed diabetes, and 4,782 people without diabetes among adults aged 18-64 years. The population percentage undetected among adults with diabetes and the odds ratio of being undetected among adults who reported not having diabetes were compared between groups based on their access to health care. RESULTS: Among those with diabetes, the percentages having undetected diabetes were 42.2% (95% CI 36.7-47.7) among the uninsured, 25.9% (22.9-28.9) among the insured, 49.3% (43.0-55.6) for those uninsured >1 year, 38.7% (29.2-48.2) for those uninsured 1 year (2.6 [1.4-5.0]). CONCLUSIONS: Limited access to health care, especi Continue reading >>

Lilly Diabetes Hosts Insulin Pricing And Access Workshop

We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. In the front lobby of Lillys corporate headquarters inIndianapolis stands a towering 12-foot tall statue of a mother holding her child in herarms, sick and starving to death due to lack of insulin. Its an artistic rendering of a real-life mother who took her son to insulin's birthplace in Toronto once upon a time, before the medication's discovery in 1921, when a diabetesdiagnosis was a death sentence. As the Lilly folks describe it today, thestatute is a visible reminder of what they are all about changing the fieldof science and getting people the medication they need to stay healthy, even stayalive. Unfortunately, the reality in 2017 is an incredible crisisin insulin affordability and access for many with diabetes, to the extentthat people in our D-Community are losing everything because of lack of insulin, and facing life-and-death situations in some cases. All of this was the big, sobering, anger-inducing backdrop ofa recent Lilly-hosted insulin access workshop on April 20, where the Pharmagiant brought in a dozen diabetes advocates to discuss actionplans to start addressing this growing crisis. This gathering came just before Lillysfirst quarter earnings call on April 24, when the company reported that just for its 20-year-old Humalog insulin alone, sales revenue in the U.S. went up 24%in the first months of this year, which generated all kinds of positive momentumon the company's revenue. Just seeing those figures made many clinch our fists in rage, and it's tough to stomach -- particularly as this issue is hitting some so hard, as shown in a NBCNightly News segment airedearlier this week and the sad story of Sha Continue reading >>

Diabetes Equity Project

Baylor Scott & White Health(formerly Baylor Health Care System) in Dallas, Texas ,created the Diabetes Equity Project (DEP) with funding from a Merck Company Foundation grant. The goal of the DEP is to reduce observed disparities in diabetes care and diabetes outcomes in the medically underserved communities surrounding Baylor hospitals.The DEP utilized specially trained, bilingual community health workers to: educate patients about diabetes and key self-management skills serve as culturally-tailored and linguistically appropriate liaisons to the patient-provider relationship increase access to health services and education Preliminary analysis revealed that participating patients had a statistically significant reduction in mean glycated hemoglobin (HbA1c) levels one year post-baseline. The toolkit provides educational materials* for patients with diabetes that will help them understand basic information about type 2 diabetes and how to manage and control their diabetes daily. Educational topics include: Type 2 Diabetes, Blood Sugar Management, Healthy Eating, and Preventing Diabetes-related Problems. The toolkit content for providers is meant to support the development of diabetes outreach programs and/or improve the diabetes care delivery process for underserved patients without access to proper diabetes education and self-management resources in an outpatient setting, including incorporating CHWs into the diabetes care delivery team. The toolkit materials will include: Visit Protocols and Supporting Materials, Patient Education Tools, Patient Knowledge Assessments, Charting Examples, Diabetes Health Promoter Training and Coaching Modules, and Quality Assurance Evaluations. The toolkit will provide resources to inform policy makers of the need for improved access to Continue reading >>

Perceived Access Problems Among Patients With Diabetes In Two Public Systems Of Care

Perceived Access Problems Among Patients with Diabetes in Two Public Systems of Care 1Received from the Center for Health Care Evaluation/HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, Calif 2Department of Health Research and Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, Calif 1Received from the Center for Health Care Evaluation/HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, Calif 2Department of Health Research and Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, Calif The views expressed in this article are those of the author and do not necessarily represent the views of the Department of Veterans Affairs. Address correspondence and reprint requests to Dr. Piette: Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park Division (152), 795 Willow Road, Menlo Park, CA 94025 (e-mail: [email protected] ). Copyright 2000 by the Society of General Internal Medicine This article has been cited by other articles in PMC. We examined the prevalence of access problems among public clinic patients after participating in trials of automated telephone disease management with nurse follow-up. General medicine clinics of a county health care system and a Veterans Affairs (VA) health care system. Five hundred seventy adults with diabetes using hypoglycemic medication were enrolled and randomized; 520 (91%) provided outcome data at 12 months. Biweekly automated telephone assessments with telephone follow-up by diabetes nurse educators. At follow-up, patients reported whether in the prior 6 months they had failed to obtain each of six types of health services because of a financial or nonfinancial access problem. Patients receivi Continue reading >>

Lack Of Insulin Access A Major Failing Of Diabetes Awareness

Tagged with diabetes awareness , diabetic ketoacidosis , insulin In the UK, insulin doesnt cost anything for diabetics who require it, but there is an estimated 50 million people worldwide who cannot afford insulin. In many countries, there is nothing that even resembles an NHS, and the cost of insulin can drive families into poverty, especially if a child becomes ill due to a lack of medication. Diabetes awareness is a broad term and often relates to peoples knowledge of the condition, but a lack of insulin is one of the biggest problems diabetics across the world are facing, and it needs to be recognised. The price of insulin a hormone which regulates glucose levels is influenced by many factors. The demand is staggering, with an estimated 100 million diabetics worldwide requiring insulin. This includes all type 1 diabetics (approximately 17.4 million people) and between 20 to 30 per cent of people with type 2 diabetes . Type 1 diabetics would die without insulin the most common cause of global death for a child with type 1 diabetesis a lack of access to insulin while type 2 diabetics denied insulin they require would be at an increased risk of amputation , blindness and kidney failure. Among the price barriers include storage and distribution costs, but it is frequently those in smaller countries with reduced markets, problems with transport and poor resources where insulin can be too costly to afford. This can lead to average HbA1c results being too high in diabetics and a higher prevalence of complications such as diabetic ketoacidosis , malnutrition and recurrent infections, resulting in premature death. While insulin is recognised as an Essential Medicine by the World Health Organisation, it is estimated that half of those that require insulin do not have access Continue reading >>

Access To Medications, Devices And Supplies & Your Rights

What is Diabetes Canada’s position on access to diabetes medications, devices and supplies? People with diabetes should have timely access to medication, supplies and medical devices that can improve their immediate quality of life and that may decrease the likelihood of future interventions which are often more costly and less effective. Federal, provincial and territorial governments should commit to the development of an effective formulary system (or systems), which is (are) mindful of products providing the best outcomes based on sound medical evidence and which do not create additional barriers to access. New products with proven efficacy should be listed in a timely fashion. Read Diabetes Canada's full position statement on access to diabetes medications, devices and supplies, including background and rationale. What is Diabetes Canada’s position on the cost of diabetes medications, devices and supplies? Federal, provincial and territorial governments should commit to a strategy such that the cost to the individual of diabetes medication, supplies and medical devices, as well as the costs associated with diabetes-related complications, are not a barrier or a burden to managing the disease. Read Diabetes Canada's full position statement on the cost of diabetes medications, devices and supplies, including background and rationale. Will my diabetes drugs and supplies be covered? Whether you are covered by a private, employer or public health plan, you cannot assume all your drugs and supplies will be paid for. Each provincial, territorial, private, and employer health plan has its own “formulary” of medications and supplies, which is a listing of drugs and supplies covered by the plan and on what conditions. Do I qualify for public drug coverage? Provincial Continue reading >>

International Diabetes Federation - Access To Medicine

of people with diabetes and those at risk Access to medicines and supplies for people with diabetes People with diabetes require medicines to control their blood glucose levels, blood pressure and blood lipids, equipment to monitor their blood glucose levels, and a health care system that is able to provide integrated and comprehensive care to all parts of the country. Unfortunately, the quality of care for people with diabetes varies widely around the world. In many high-income countries, people with diabetes have access to all components of care. In some other countries, quality care is inaccessible or unaffordable. Continuous accessibility to medicines is still a major problem in many less-resourced areas, especially in low- and middle-income countries. In the case of insulin, the lack of a reliable and continuous supply can lead to severe illness and death. The International Diabetes Federation estimates that approximately 5 million people die each year as a consequence of diabetes. Many of these deaths could be prevented with proper access to medicines and supplies. Often the total supply of the medicine is less than required, there are transportation problems, or the medicine is not available in regional areas. Solutions to improving access include increased education of health professionals, reducing taxes and duties, promoting competition and high-quality generic medicines, differential pricing, good procurement practices, and open access to pricing information. Global survey on Access to Medicines and Supplies for People with Diabetes In 2016, IDF conducted a global survey on the perspective of people with diabetes and health professionals on Access to Medicines and Supplies for People with Diabetes. The report introduces diabetes and related medicines, provid Continue reading >>

Diabetes Access Action Center

A recent decision by United Healthcare has set a dangerous precedent for restricting patient access to therapies prescribed by their healthcare professionals. The diabetes community must come together to ensure this decision does not represent the beginning of a larger, dangerous trend. If this happens, access to lifesaving management tools will be limited or eliminated entirely and competition in the marketplace that spurs innovation and results in better tools for patients will be reduced. And patients will suffer. This is about us, and we MUST join together and use the power of our collective voice to prevent actions by payors that limit access. Who should prescribethe best treatment: the medical teamwho knows them as a patient, or theinsurance company who knowsthem simply as a number? Formulary restrictions and preferred provider agreements, according to health insurance companies, improve care and save money. The standard of care starts with a focus on Patient-Centered plans, explicitly stating, one size does not fit all. Specifically adding, Clinical practice guidelines are key to improving population health; however, for optimal outcomes, diabetes care must be individualized for each patient. Does It Empower Patients and their care teams to drive success with diabetes? The ultimate question. Does it clearly comply with ADA's 2016 peer-reviewed standards of care? Treatment decisions should be timely and based on evidence-based guidelines that are 2016;39(Suppl. 1):S6S12 | DOI: 10.2337/dc16-S004 Restricting access to treatment as prescribed by a medical professional restricts optimum health outcomes. A preferred or exclusive treatment option is not an option at all; it is a barrier to the best outcomesfor each individual with diabetes. he diabetes community,which Continue reading >>