• Posted February 28, 2023

Too Few Americans With Diabetes Are Getting Recommended Meds

Most Americans with type 2 diabetes are candidates for newer, pricey medications, but few are getting them, a new government study shows.

Researchers found that of U.S. adults with the blood sugar disease, over 80% could stand to benefit from the medications, based on recommendations from the American Diabetes Association (ADA). But only 10% of those people were actually taking the drugs in recent years.

It's not clear why. The researchers, from the U.S. Centers for Disease Control and Prevention, said the point of the study was to get a handle on where things stand: How many Americans meet the latest criteria for the diabetes drugs, and how many are already using them.

"It's critical that we continue to study the best ways to manage type 2 diabetes -- including medications and lifestyle changes -- but it's also important to examine how available these methods are to people," said lead researcher Shichao Tang, of the CDC's division of diabetes translation.

Over 37 million Americans have diabetes, the vast majority of whom have the type 2 form, according to government figures. Type 2 diabetes develops when the body can no longer properly use the hormone insulin, which regulates blood sugar. Over time, the disease can lead to serious complications like heart disease, stroke and kidney disease.

For years, the first-line therapy for type 2 diabetes has been metformin -- a cheap, oral drug that lowers blood sugar.

But in recent years, two new classes of diabetes drugs have been approved: SGLT2 inhibitors, which include oral medications like canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance); and GLP-1 receptor agonists, like liraglutide (Victoza) and semaglutide (Ozempic), which are usually delivered via injection.

Both the ADA and the European Association for the Study of Diabetes have thrown their weight behind the new drugs in the past several years -- first recommending them in addition to metformin for diabetes patients who also have heart or kidney disease.

That was based on clinical trials showing the drugs cut the risks of complications like heart attack, stroke and kidney failure.

Those recommendations have been incrementally updated. The latest advice, issued last year, says the medications should also be considered for people who do not have heart disease but are at increased risk for it. That generally means older adults with conditions like high blood pressure and obesity.

In addition, metformin is no longer the default first-line. The new, far more expensive, drugs can be as well.

Based on the latest findings, that could translate into a huge number of people.

The CDC estimates that between 2017 and 2020, 82% of U.S. adults with type 2 diabetes would have qualified for a GLP-1 or SGLT2 medication, based on the latest recommendations.

But only 1 in 10 of those people was actually taking one of the drugs. The findings were published as a research letter in the Feb. 28 issue of the Annals of Internal Medicine.

The reasons are unclear, according to Tang. He noted that during the study period, the medications were not yet recommended as first-line options -- though they were considered "second-line."

The drugs are also very expensive, with retail prices in the hundreds to over $1,000 per month. Cost could be a "barrier to use," Tang noted.

But for the right candidates, the potential benefits of the medications are substantial, according to Dr. Robert Gabbay, the ADA's chief scientific and medical officer.

Gabbay said that if used as recommended, the drugs can "significantly lower" the risks of cardiovascular and kidney diseases.

"This report is a troubling reminder that far too few of those who could benefit from these treatments have the access they need," he said.

At the societal level, the price tags on GLP-1 and SGLT2 medications could weigh heavily if they are widely adopted as first-line treatments. The CDC team points to a recent study estimating that the current prices would have to be slashed by 70% to be "cost-effective."

For any one person with diabetes, though, the decision is individual, Tang said: People have to talk with their doctor about the benefits and risks of any medication.

And, as the ADA recommendations say, medications are only part of the picture. Regular exercise and good nutrition are also key to controlling diabetes. The ADA says everyone with diabetes should have access to diabetes education providers -- who can help them in putting together a plan to manage the disease.

Tang echoed that. "People should talk to their health care providers about the best ways to manage diabetes, including medications, lifestyle changes and services to help manage diabetes," he said.

More information

The U.S. Centers for Disease Control and Prevention has advice on managing diabetes.

SOURCES: Shichao Tang, PhD, division of diabetes translation, U.S. Centers for Disease Control and Prevention, Atlanta; Robert Gabbay, MD, PhD, chief scientific and medical officer, American Diabetes Association, Arlington, Va.; Annals of Internal Medicine, Feb. 28, 2023, online