Diabetics are increasingly risking life and limb by cutting back on — or even going without — doctor visits, insulin, medicines and blood-sugar testing as they lose income and health insurance in the recession, an Associated Press analysis has found.
Doctors have seen a drop in regular appointments with diabetic patients, if they come back at all. Patients more often seek tax-subsidized or charity care. And they end up in emergency rooms more often, patients and physicians said in interviews.
Sales of top-selling drugs and other products used to treat and monitor the disease have dropped since the economic crisis accelerated last fall, the AP analysis found. There are even signs that some patients are choosing less-expensive insulin injections over pricier pills to save money.
Meanwhile, the number of people with the disease keeps growing — another 1.6 million Americans were diagnosed in 2007 alone.Risking dire complications
People with other health problems also are cutting back on care amid the recession, but diabetics who don't closely monitor and control the chronic disease risk particularly dire complications: amputations, vision loss, stroke — even death.
Patients' frugality comes at a tremendous cost to the already-strained health care system. The typical monthly bill to treat diabetes runs $350 to $900 for those without insurance, a price tag that's risen as newer, more expensive medicines have hit the market. Emergency care and a short hospitalization can easily top $10,000, and long-term complications can cost far more.
Diabetes occurs when the body doesn't make enough insulin or doesn't efficiently use the hormone, which helps turn sugar from food into energy. The disease can be kept under control by monitoring blood sugar as well as exercising, improved diet, medications, testing and regular checkups.
Uncontrolled diabetes can cause fatigue, blurry vision, excessive urination, gum problems, infections and wounds that don't heal. Damage to the kidneys, liver, heart and eyes follow. Often, much of that damage isn't apparent until a stroke or heart attack strikes.
Sales have dipped for pricey brand-name diabetes pills, blood glucose monitors and even test strips, based on industry sales figures and interviews with the top two makers of testing supplies. The strips generally cost $1 or more each; patients using insulin are supposed to test at least two to four times a day to be sure their blood sugar is in a safe range.
Sales down as cases grow
Johnson & Johnson, a maker of top-selling OneTouch blood sugar meters, testing strips and insulin pumps, reported a 2 percent fourth-quarter drop in U.S. sales for the category compared with the same period a year earlier, a large drop considering quarterly sales up to then had been rising at around 10 percent.
Long-term consequences
Getting patients to stick to their treatment has long been tough. But rising unemployment has made things worse.
At a family clinic in impoverished Newark, N.J., so many patients simply stopped showing up after losing health insurance that doctors posted notices asking clients with financial troubles to speak up so staff can try to help.
"Sometimes you don't see (diabetes) patients for several months," said Dr. Cynthia Paige, medical director of the New Jersey Family Practice Center. They "don't understand what a nightmare uncontrolled diabetes is and how it's ravaging your body," she said.
Emergency rooms increasingly are treating diabetics who haven't been taking medicines, according to doctors at several hospitals nationwide and the professional group for ER doctors. Many of the patients have blood sugar so high they are hospitalized for days. Free clinics also are getting a surge of diabetes patients desperate for help.
"There's an increase in just overall consequences of diabetes: losing a foot, losing a kidney, bad eyesight. At least six people come to mind over the last six months ... most because of the recession," said Dr. Nicholas Vasquez, who works in one of the country's biggest ERs, at St. Joseph's Hospital in Phoenix.
Vasquez and his colleagues view the desperate patients in their ER as harbingers of what's to come if the recession deepens.
"What we're seeing mostly is the first steps of people not taking care of their diabetes and starting to have consequences," he said.
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