Advocates: COVID a ‘wake-up call’ to seriousness of diabetes

A progressive bill with bipartisan support that would cap the cost of insulin and supplies for diabetics could be considered during a special legislative session this summer.

The bill had bipartisan support from all four caucuses and has already been given a public hearing. It passed the legislature’s Insurance and Real Estate Committee with nearly unanimous support in early March, before the session was cut short due to COVID-19. But some kinks still needed to be worked out in the legislation.

“It’s one of those situations that I think that if we make this smart policy choice and invest some resources here, it will actually save on a lot of the health issues that occur or result from people who don’t have the means to take the proper dosage of insulin and the more expensive health problems they experience as a result,” said State Sen. Kevin Kelly, the ranking Republican on the legislature’s insurance committee who helped write the proposed legislation

The bill would cap costs at $50 for each 30-day supply of insulin, $50 per month for prescribed non-insulin drugs and $100 for a month of necessary supplies. Colorado, Illinois, Maine, New Mexico, New York, Utah, Washington and West Virginia have all recently passed similar caps.

Both Democrats and Republicans in the General Assembly have voiced support for the bill, as have insurance companies, though they’ve warned it won’t lower the underlying high cost of insulin, which is set by the three main pharmaceutical companies who make the drug.

There have also been questions about the effectiveness of the legislation — which applies only to the so-called fully-insured market, or just 32 percent of the state — and how many people its passage will positively impact.

The bill would come in the context of a global pandemic that has laid bare issues of racial inequity in health care. As a result, questions about the bill extend, in particular, to low-income and minority communities, who are already more predisposed to Type II diabetes and who have been disproportionately hurt by the coronavirus pandemic and lack access to health care.

Black Connecticut residents are 2.5 times more likely to die from the coronavirus than their white neighbors and Hispanics have a death rate 67 percent higher than non-Hispanic whites, according to a CTMirror.org analysis of data released by the governor’s office.

And according to the Centers for Disease Control and Prevention, Black and Hispanic Americans have among the highest prevalence rates of diabetes (only Native Americans have a higher rate). The confluence of both health crises has produced catastrophic results, according to some diabetes advocates.

“The alarming COVID-19 mortality rate in America’s communities of color can be directly attributed to problems with health access and resources — the same issues, which link these communities to disproportionately high rates of diabetes and related chronic diseases,” said Tracey D. Brown, chief executive officer of the American Diabetes Association (ADA). “Those with the fewest resources are the least likely to have access to quality health care, and COVID-19 testing is no exception.”

But at least some are hopeful the virus might bring awareness to persisting issues in certain communities with particularly high rates of diabetes and emphasize the importance of the legislative changes — including caps to the cost of treatments — needed to ensure better access to care.

Diabetes and the pandemic

According Brown, the struggles of diabetics in Connecticut and nationwide, especially those living in low-income communities, only became more pronounced during the coronavirus pandemic.

“Before COVID-19, this country found itself in a diabetes epidemic,” Brown said. “Now with this COVID-19 pandemic, folks with diabetes or any other underlying condition, if they contract COVID-19, there is a higher risk of worse outcomes.”

Diabetics who do not manage their disease well — and whose blood sugarlevels fluctuate — tend to be at greater risk for serious COVID-related outcomes, according to the ADA. Thus the need for affordable treatment, which Brown said could cost an uninsured person $100 or more for a vial of insulin.

But management can be difficult. Blacks, for example, are twice as likely as whites in Connecticut to be uninsured, according to Dr. Cato Laurencin, an Albert and Wilda Van Dusen distinguished professor of orthopedic surgery at UConn Health and editor-in-chief for the Journal of Racial and Ethnic Health Disparities.

Lack of insurance creates a clear barrier to treatment of diabetes, as well as COVID.

In densely populated, urban communities — whose residents were disproportionately deemed as essential workers — where rates of infection were highest, testing was most difficult to come by for much of the pandemic. Many sites required a prescription from a doctor — a difficult task for an uninsured person without a primary care physician. Others, that didn’t require a prescription, offered drive-through testing — a challenge for people who rely on public transportation in Connecticut’s cities or might not be able to afford their own vehicle.

“People at the economic fringes or in fragile communities tend not to have access to health insurance and health care,” said Lorenzo Boyd, an assistant provost for Diversity & Inclusion, director of the Center for Advanced Policing and associate professor at the University of New Haven. “A lot of poor people don’t have primary care physicians. When they get sick, it has to be serious enough for them to get into an emergency room. If they wait until it gets bad, they completely miss out on preventative care.”

Health disparities

The COVID-related complications for diabetics are especially alarming given the vastness of the problem in America, Brown said.

According to the CDC’s 2020 National Diabetes Statistics Report, 34.2 million people in the United States had diabetes in 2018, and more than one in three adults have pre-diabetes. In Connecticut, 8.5 percent of all adults had diagnosed diabetes in 2016.

Of all adult cases nationwide, 90 to 95 percent are Type II diabetes, according to CDC estimates. Brown said that according to early estimates from her own organization, as many as 40 percent of COVID-related deaths in some states were diabetics.

There is no simple explanation for this, Brown said, but environmental factors in neighborhoods with high prevalence rates of diabetes and COVID are likely responsible.

“We know that traditionally what are called social determinants of health — like environmental factors, where you live, education level, income level — all of these play a very large factor in the prevalence of diabetes in communities of color,” said Brown, who has been living with diabetes for 16 years. “A lot of those things go back to access to health care. Many of these communities don’t have access to health care.”

Risk factors for Type II diabetes include being overweight, inactivity and family history of the disease — among others — which can be exacerbated by living in certain neighborhoods.

“The health disparities have been here, COVID just signed a brighter light on them,” said Diane Lewis, of the Hartford-based social justice organization Voices of Women of Color. “We have people here with no health insurance. They’re not getting proper health care. There are no grocery stores, so they can’t get proper food.”

Food deserts — areas in which residents have limited access to nutritional and affordable food — and nutritional inequality are primarily concentrated in low-income, urban neighborhoods. According to Lewis, the nearest grocery store for most Hartford residents is across city lines in West Hartford.

But access to healthy food is just one of many factors contributing to high rates of Type II diabetes, Laurencin said.

“In Black and brown communities, we have what I call ‘exercise deserts,’” Laurencin said, referring to a term he said he coined. “People talk about food deserts, in terms of not having food or markets. But we actually have exercise deserts — areas in the urban world where you can’t go running, you can’t go jogging, you can’t exercise, you can’t even walk around your property because of the types of spaces that are there.”

What can be done?

Among the ADA’s priorities during the coronavirus pandemic have been expanded access to testing in lowincome, high-risk communities, continuity of health insurance for those who may have lost jobs during the health crisis and zero-cost co-pays on insulin.

Testing has been expanded, though there are still barriers in certain communities, and the enrollment period for Husky Care — the state’s health insurance marketplace — was extended. But many of the state’s most vulnerable residents are still excluded.

Laurencin, through the Connecticut Convergence Institute, has created two programs to address food and exercise deserts. One, called the Just Us Moving Program (or JUMP), is meant to educate high-risk communities on the importance of physical activity, while the other, called the Health Cafe Series, is intended to educate on healthy behaviors.