Patients risk major long-term consequences as they struggle to afford managing diabetes with financial realities.
A recent survey by the Centers for Disease Control and Prevention (CDC) found that patients with diabetes that are 45 to 64 years old frequently reduce or delay taking their medications to save money.
The CDC’s National Health Interview Survey conducted in 2015 found that among those older adults diagnosed with diabetes, 18 percent put off taking their pills or refilling a new prescription on time to save money.
They were nearly twice as likely as people in that age group with other diseases or ailments to reduce their medication or delay refilling a prescription.
There were a number of different strategies used by these adults to cut costs.
The most common method was delaying filling a prescription, which 16 percent of them had done in the past year.
In addition, 14 percent took less medication than was prescribed, and 13 percent skipped medication doses.
Among adults 65 or older, people with diabetes reduced their medication more than other adults in the same age group, but at a narrower margin: 6.8 percent vs. 4.7 percent.
Lack of immediate symptoms
According to the CDC, 29 million Americans have type 1 or type 2 diabetes, up from 26 million in 2010.
Type 2 diabetes accounts for 95 percent of all cases.
“Diabetes is a chronic disease, so the really bad things that are associated with diabetes tend not to happen immediately, but are five years or 10 years down the road,” said Evan Sission, PharmD, certified diabetes educator, and spokesperson for the American Association of Diabetes Educators (AADE).
“Diabetes is a syndrome of several different diseases. Patients often have high blood pressure, elevated cholesterol levels, and kidney disease. All these things are running concurrently,” Sisson told Healthline. “So, if they skip their medication for cholesterol, let’s say, they may not feel any effects at all.”
In fact, they may actually feel better if they had been experiencing side effects from the necessary medication.
The lack of immediate consequences from skipping pills is a common reason people do not stick to medication.
“Diabetes isn’t like chronic pain, where if a patient misses their pain medication, they immediately think ‘I need to take my pain medication’. Patients with diabetes don’t necessarily feel the effects,” Sisson said.
Long-term effects of skipping medicine
The long-term consequences of not controlling diabetes are severe.
Sission says that clinical trial data shows that it puts patients at increased risk of blindness and kidney damage, which would require dialysis, and nerve damage.
Further down the road, it puts them at risk of heart disease as well, Sisson says.
Nerve damage can lead to some major problems. It often results in a similar type of feeling that someone gets temporarily when their foot falls asleep if they’ve cut off circulation.
People with diabetes whose feet are always asleep may not notice when they’ve hurt themselves.
The cut or burn they can’t feel then becomes infected and their limb may need to be amputated to keep the infection from spreading.
“Diabetes is the number one cause of preventable amputations in the U.S.,” Sisson said.
There are also dangers when someone with diabetes cuts back on their medication. It can result in a slightly higher than average blood sugar level for an extended time.
The same can be true if someone refills a prescription a month late. That can result in an extremely high blood sugar level for a shorter amount of time.
“The risk of damage goes up exponentially the further away from the normal level the patient lets their blood sugar sit, and the longer the period of time,” Sisson says.
The peril of not managing diabetes isn’t reversible. Sisson says.
“Once the long-term effects begin to happen, it’s too late most of the time,” he explained. “You can’t revise nerves that are dead or damage that’s happened to the eyes. The damage has already been done.”
Having diabetes is expensive
People diagnosed with diabetes spend an average of $13,700 on medical expenses per year. About $7,900 is linked to diabetes, according to the American Diabetes Association.
Type 2 diabetes is often caused by an unhealthy diet and obesity. Therefore, when people are diagnosed with diabetes, it usually comes along with several other conditions.
Treating each condition comes with a price.
According to Sisson, it usually takes one to two medications to manage glycemic control, one or two medications for cholesterol, and two to three medications for blood pressure.
“Already you’ve prescribed seven medicines and you haven’t even touched on the fact that they might have COPD or kidney damage. The costs for the patient start to add up very quickly,” Sisson says.
Aside from his work as an assistant professor at the Virginia Commonwealth University’s School of Pharmacy, Sisson practices at a free clinic nearby.
He meets several patients with diabetes who don’t have health insurance and don’t qualify for Medicaid or Medicare.
“They’re essentially the working poor,” he said.
Sisson explains why, for many Americans, paying for their pills isn’t a priority.
“From their viewpoint, they need to have a house and feed their family — everything else falls behind,” he said.
Even with health insurance, many can’t afford medicine.
“Even copays at $4 a prescription start to add up, and patients can’t afford the prescriptions that they need,” Sisson said.
Tough to manage regardless of cost
People with diabetes who skip or reduce their treatment are many times making the best choice they can with the funds they have available, Sisson says.
However, like many other chronic diseases, it’s cheaper overall to invest the money to stay healthy now.
“If we as a country could ease that health burden, they could focus on the other social burdens they have with the limited income that they have,” Sisson points out.
“Diabetes can seem costly, but it is important for patients to realize that sticking to their provider’s prescribed medical regimen will lower their costs down the line. The cost to the patient living a healthy life compared to complications from diabetes — like loss of a limb — is what’s at stake,” David Weingard, chief executive officer of Fit4D.com, told Healthline.
“Insulin is not a luxury, but rather it is lifesaving and life-sustaining for millions of people with type 1 and type 2 diabetes, many of whom will need insulin every day for the rest of their lives,” added Dr. William T. Cefalu, chief scientific and medical officer of the American Diabetes Association (ADA).
“We [the ADA] are distressed that the costs of healthcare, and medications are causing many to face tough choices — to pay exorbitant costs for the medications they need to stay alive or to pay for other basic living expenses,” Cefalu told Healthline.
Costs won’t only increase for individuals, but for the United States as a whole.
The ADA has determined the total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in medical costs and $69 billion in reduced workplace productivity.
That cost has risen 41 percent since 2007, showing the growing burden on the U.S. economy, not to mention the potential physical and emotional suffering of patients with diabetes.
“There is no avoiding the problem of chronic disease — it’s here,” Sisson stated. “Kept unchecked, the downstream effects of poor control of diabetes are going to be much more expensive than managing these folks right now. The way to keep the workforce employed and viable is to address their chronic disease now.”