Di­a­betes fund­ing life­saver

The break­through could ex­tend the lives of 120,000 Ki­wis bat­tling the dis­ease

The New Zealand Herald - - Front Page - Nicholas Jones

New-gen­er­a­tion di­a­betes drugs are set to be pub­licly funded — a break­through that could keep up to 120,000 New Zealan­ders in good health and alive longer.

Phar­mac has an­nounced it wants phar­ma­ceu­ti­cal com­pa­nies to sub­mit pro­pos­als for the sup­ply of new medicines to help Ki­wis bat­tling type 2 di­a­betes.

A lead­ing di­a­betes clin­i­cian says the drugs be­ing con­sid­ered are “lifechang­ing and life-sav­ing” — but Phar­mac’s pro­posal meant they would be used only for spe­cial cases or as add-ons to the ex­ist­ing poor stan­dard of care.

“They must be funded for full open ac­cess, and as sec­ond and third-line treat­ments,” said Dr John Baker, chair­man of the Di­a­betes Trust.

About a quar­ter of a mil­lion Ki­wis have di­a­betes, and an­other 100,000 are thought to be un­di­ag­nosed. Around 90 per cent have type 2, the sort mostly brought on by life­style and linked to obe­sity.

Phar­mac’s deputy med­i­cal di­rec­tor, Dr Peter Mur­ray, said pa­tients and clin­i­cians had been ask­ing for the new medicines to be funded.

“Ev­i­dence sug­gests these medicines do more than just re­duce sugar lev­els in peo­ple with type 2 di­a­betes. They can also help ad­dress re­lated com­pli­ca­tions like kid­ney and heart dis­ease.

“We hope to fund at least one of these medicines by ne­go­ti­at­ing with medicine sup­pli­ers and run­ning a com­pet­i­tive pric­ing process.”

The new medicines are called SGLT-2 in­hibitors, GLP-1 ag­o­nists and DPP-4 in­hibitors. Phar­mac has is­sued a re­quest for pro­pos­als (RFP), some­thing done when more than one medicine is avail­able to treat a con­di­tion, such as when there are mul­ti­ple brands or when dif­fer­ent medicines have a sim­i­lar ther­a­peu­tic ef­fect. The process could take sev­eral months.

It comes af­ter an on­go­ing Her­ald in­ves­ti­ga­tion into the grow­ing toll of di­a­betes, with am­pu­ta­tions now top­ping 1000 ev­ery year as clin­i­cians and pa­tients strug­gle with the worst range of funded di­a­betes drugs in the de­vel­oped world.

Re­spond­ing to those find­ings in Oc­to­ber last year, As­so­ciate Health Min­is­ter Peeni Henare re­vealed talks with Phar­mac about fund­ing bet­ter drugs, and said he per­son­ally sup­ported tough mea­sures in­clud­ing a sugar tax and warning la­bels on junk food (a sugar tax has been ruled out by the Prime Min­is­ter).

Last night, Henare said Phar­mac’s an­nounce­ment was “a pos­i­tive step in the right di­rec­tion” and the medicines had the po­ten­tial to ben­e­fit about 120,000 Ki­wis liv­ing with type 2 di­a­betes and at risk of fur­ther com­pli­ca­tions. “The num­ber of New Zealan­ders with di­a­betes is grow­ing and the bur­den of this dis­ease dis­pro­por­tion­ately falls on peo­ple liv­ing in de­prived com­mu­ni­ties . . .” Henare said.

“A wide range of tools and ap­proaches are needed, in­clud­ing pre­ven­tion — life­style changes, diet, phys­i­cal ac­tiv­ity, and early in­ter­ven­tion to turn this tide.”

Baker, who as well as chair­ing the Di­a­betes Trust is a spe­cial­ist at Mid­dle­more Hos­pi­tal, said the medicines were the first of a new gen­er­a­tion of drugs that re­duce car­dio­vas­cu­lar deaths and pro­gres­sion to re­nal fail­ure.

“Cur­rently funded med­i­ca­tions do not do this. The new drugs are also as­so­ci­ated with lower in­ci­dence of side ef­fects. They cause weight loss — rather than weight gain — and they do not cause hy­po­gly­caemia [low blood sugar]. Com­bined with be­ing rel­a­tively cheap and easy to use, these drugs are life-chang­ing and life­sav­ing.” How­ever, Baker said Phar­mac’s pro­posal was “dev­as­tat­ing” be­cause it would only al­low the medicines to be used rarely and in ad­di­tion to the cur­rent stan­dard of care, which in­ter­na­tional di­a­betes as­so­ci­a­tions had deemed third world.

“Phar­mac should be un­der no il­lu­sion — af­ter 20 years of wait­ing, clin­i­cians will not ac­cept an out­come where these medicines are funded only for spe­cial cases or only as ad­juncts to the ex­ist­ing poor stan­dard. They must be funded for full open ac­cess, and as sec­ond and third­line treat­ments.”

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