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Diabetics and the Recession

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, the Associated Press says.

The AP found that doctors have seen a drop in regular appointments with diabetic patients. 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 found; to save money, some patients appear to be choosing less-expensive insulin injections over pricier pills.

People with other health problems also are trimming 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 big cost to the already-strained healthcare system. The typical monthly bill to treat diabetes is $350 to $900 for the uninsured, a cost that has risen with newer, more expensive medicines. Emergency care and a short hospitalization can easily top $10,000;long-term complications can cost far more.

In one case the AP examined, an Indianapolis woman had to be rushed to a hospital and spent a week there recovering from a life-threatening episode after she stopped taking most of her prescribed drugs and halved her insulin dosage following her husband's layoff and loss of their insurance.  A free clinic in California reported a 30% increase in six months in requests for free diabetes medicines and supplies, as the recession took jobs and insurance.

Since last June, sales of the most widely used diabetes pill, $4-a-month metformin, were up 7%, and sales of brand-name versions of the same drug, costing 10 times as much, were down an average of 9%, according to the AP's analysis of figures from health-data firm IMS Health Inc.  By February, sales for nearly every other category of diabetes pills and insulins were down from a year earlier, most by double digits, the AP said IMS figures showed. The only exceptions were a new type of diabetes pill, Januvia, and advanced insulins that tightly control blood-sugar levels.

Emergency rooms increasingly are treating diabetics who haven't been taking medicines, according to doctors at several hospitals nationwide and the ER physicians' professional group. Many patients have blood sugar so high they are hospitalized for days.

"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," Dr. Nicholas Vasquez, who works in one of the country's biggest ERs, at St. Joseph's Hospital in Phoenix, told the AP. He said he and his colleagues view the desperate patients in their ER as harbingers of what will happen if the recession worsens.

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