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New Diabetes Drug Funding Format Is “Unethical”

An organisation which has campaigned to change the drugs used in New Zealand to treat Type 2 diabetes says Pharmac’s announcement today of limited funding for the ‘new’ drugs leaves at least 200,000 patients on a regime now only practiced in the third world.

Chairperson of the Diabetes Foundation Aotearoa, Dr John Baker, is upset that Pharmac won’t replace the standard of care, and instead forces desperate patients and clinicians to apply for ‘special authority’ to use any of three new classes of drugs (each is at least 15 years old).

“It is unethical to withhold these medicines, now standard across the first world, and keep four out of five patients on a regimen that makes their lives unbearable or short.

“We understand the need to limit costs in the health budget, but this is like rationing instant coffee in the tearoom.

“I am extremely happy for those who will get access to the drugs – they are life-changing - but I’m extremely sad for the 200,000 who won’t, because their lives will remain deeply difficult.”

The Foundation estimated in a submission to Pharmac that New Zealand’s long delayed adoption of modern diabetes medicines would lead to the preventable death of about 800 people each year (491 deaths each year could be prevented by the use of SGLT-2, and 286 deaths by use of GLP-agonist drugs. A further 99 renal replacement therapies (dialysis) could be avoided by use of SGLT-2).

“We’ve wrung everything we can out of these ancient medicines – it’s time to move to new drugs to reduce premature deaths, and progress to kidney failure,” Dr Baker says.

The medicines New Zealanders currently get include Metformin IR, first used 1957, Sulphonylureas such as Glipizide, first used 1956, and Insulin first used 1922. This approach was only recommended for third world countries, by the American Diabetes Association & European Association for the Study of Diabetes in a joint consensus statement in September 2018. Pharmac’s approach means this will remain the standard of care in New Zealand.

The medicines used as standard of care in the rest of the developed world are Metformin XR, first used 2004, SGLT-2 inhibitors, first used 2013, and GLP-agonist, first used 2005.

Dr Baker thinks clinicians should be morally bound to apply for special authority to treat every one of their patients.

“Almost every patient would experience a vast improvement in their diabetes from these new drugs; they would lose weight, and feel well enough to work and play.”

“Clinicians should apply for the special authority and refuse to take ‘no’ for an answer,” Dr Baker says.

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