New Diabetes Treatments Will Take Your Raises and Increase Your Insurance Premiums

Providing care for patients with type 2 diabetes is very expensive. One in 4 dollars spent on healthcare in the United States goes is used to treat patients with diabetes. Their direct care costs consume nearly one third of a trillion dollars. “On average people with diabetes incur annual medical expenditures of $19,736, of which approximately $12,022 is attributable to diabetes. People diagnosed with diabetes, on average, have medical expenditures 2.6 times higher than what would be expected without diabetes…the inflation-adjusted direct medical costs of diabetes are estimated to rise 7% from 2017 and 35% from 2012 calculations (stated in 2022 dollars)…. the absolute number of people with diabetes has grown and contributes to increased health care expenditures, particularly per capita spending on inpatient hospital stays and prescription medications. The enormous economic toll of diabetes continues to burden society through direct medical and indirect costs….the largest contributors to the cost of diabetes are higher use of prescription medications beyond glucose-lowering medications ($84.5 billion), higher use of hospital inpatient services ($96.2 billion), medications and supplies to directly treat diabetes ($51.3 billion), and office visits to physicians and other health providers ($33.6 billion) relative to the population without diabetes.”

Most of you have health insurance from your employer. Most employers are self-insured meaning that they pay your claims dollar-for-dollar. Your “insurance company” does not provide insurance. It merely administers health care bills, but your employer pays the bill. The economics are very clear and every American has a stake in this issue. Very high health care costs take away from your direct pay and raises and they make your company less competitive because they increase the cost of the products your company produces.

New diabetes drugs like Wegovy cost $1300 per month or $15,600 dollars a year. That will nearly double the expense of taking care of patients with type 2 diabetes. That will have a huge impact on your employer and your compensation. It will increase insurance premiums. It is like one and one are two.

Here is the good news! There is a way out. There is a very reasonable way to control diabetes less expensively and more permanently. Since 1960, obesity rates in the US have tripled. In 1958, one percent of American had diabetes. In some counties in America almost 18% of the adult population has diabetes currently. We can’t spend $35,000 per diabetic and make it. Nine out of ten people with diabetes have type 2 diabetes and that disease is all about weight and food. This is not a theory for me. It is something I have lived. Twenty years ago, I weighed 307 pounds, and my fasting sugar was 107. I was prediabetic. I started on metformin, and started eating real, whole food. People with prediabetes are much more likely to develop type 2 diabetes, but I lost 70 pounds by changing what I eat, and my sugar is never over 100 anymore. I will never need Wegovy.

If you have type 2 diabetes, in many ways this has been done to you. We are heavier today in large measure because of the food industry. Our country’s journey towards epidemic obesity and diabetes began in 1965 when the Sugar Research Foundation sponsored a literature review published in the New England Journal of Medicine which blamed fat and cholesterol for arterial disease and downplayed evidence that sugar consumption also played a role. It misrepresented the facts.

Sugar is the most addictive food. Cereal, juice, and soda companies have been pushing sugar to your kids on commercials during Saturday morning cartoons for decades. Other processed and fast food companies have learned that combining fat, salt, sugar, and carbs creates products that many of us will eat when we are not hungry and the more we eat the more we want. The first step in saving tens of thousands of dollars a year on healthcare is to eat whole real food while avoiding sugar and cutting way back on carbs. That is the only permanent way to avoid diabetes. Some companies claim they can reverse diabetes using diet. I don’t buy that, but it does show how powerful your food choices are. There is nothing you can do for diabetes that will allow you to eat these foods as often as you may like to. To control diabetes, we must change what we eat.

Diabetes is a weight disease. It makes no sense to me to give people with type 2 diabetes medications like metoprolol, glipizide, and insulin unless you have no alternative. These medicines cause weight gai. Weight gain aggravates the diabetic disease process. Avoid these medicines and depend more on diet if you can. Take medication like metformin that favor weight loss or medications that are weight neutral.

The risk of diabetes begins with obesity and increases with prediabetes. The landmark diabetes prevention program published over two decades ago used diet and exercise or metformin to prevent diabetes. Diet and exercise reduced the risk of diabetes by 58% and metformin reduced the risk by 31%. Over a 15-year period of follow-up, diet and exercise reduced new diabetes by 27% and metformin reduced it by 18%. I used diet, exercise, and metformin and my weight is down by 70 pounds. My fasting sugar is lower than it was 20 years ago.

Once you become diabetic, diet and metformin still slow the progression of disease so that your need for expensive drugs like Wegovy or injections like insulin are dramatically delayed. Semaglutide is the active ingredient in Wegovy which is promoted for reducing cardiovascular events. It does reduce cardiovascular death, nonfatal heart attack, or nonfatal stroke. by about 26% compared with placebo. 2.9% of the patients on semaglutide had a heart attack vs 3.9% on placebo. There was no difference in deaths.

That is a very modest benefit compared with optimal medical therapy (OMT) combining diet, exercise, lisinopril for high blood pressure, a statin for cholesterol, metformin for diabetes, and an aspirin to prevent clots which you can get for $31 a month with no insurance. Patients on optimal medical therapy had one fourth as many heart attacks, one fifth as many strokes, and one sixth as many people went on dialysis. In this study, there were 80 people in the OMT group and 80 in the usual care group. After 13 years, half (40) of the usual care patients were already dead, compared with 26 in the OMT group. There is no comparison. OMT is much more effective than these very expensive drugs in preventing devastating complications and death in patients with diabetes.

Don’t be fooled by slick ads with happy singing people in them. Somebody is paying $15,600 a year for Wegovy and you will gain weight when you stop taking it if you don’t change what you eat. It is not a permanent solution. OMT is the best answer for your diabetes. You and your employer can save a lot of money and still get much better results.