Racial, ethnic, and socioeconomic disparities that limit access to diabetes medications and technologies lead to poor glycemic control, diabetic emergencies, and adverse cardiovascular outcomes, according to Sara Jane Cromer, MD, Massachusetts General Hospital.
“And clinicians can play a big role in improving equity by examining their own implicit biases and advocating for more equitable health systems,” said Dr. Cromer, the opening presenter in the Scientific Sessions symposium Disparities in the Use of Diabetes Medications and Technologies. The session was originally presented Monday, June 6, and can be viewed on-demand by registered meeting participants at ADA2022.org.
Dr. Cromer said patients, providers, and health systems all play a role in perpetuating disparities. Rising medication costs and funding disparities for hospitals serving minority populations also contribute, as do state-to-state variations in Medicaid expansion, qualifications, and work requirements.
Colette Dejong, MD, University of California, San Francisco, discussed how out-of-pocket costs under Medicare Part D impact access to diabetes medications. There are exciting advances in oral diabetes medications that have led to a shift toward prescribing brand name medications, Dr. Dejong said. But Medicare Part D beneficiaries may see out-of-pocket costs for those drugs rise by eight-fold, and those high costs can lead to medical rationing, she said.
Physicians and pharmacists can help decrease disparities by learning the cost of the drugs that are prescribed and talking to patients about high prices like they would drug side effects, Dr. Dejong said. They should also find out which sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are covered under patients’ Medicare Part D plans and put them in touch with mail order pharmacies. Directing diabetes patients to GoodRx coupons and manufacturer rebates also helps, she added.
“And don’t let the perfect be the enemy of the good,” Dr. DeJong said. “Guidelines support more traditional medications if newer ones are too costly.”
Ananta Addala, DO, MPH, Stanford University, discussed strategies to avoid health inequities in access to diabetes technologies. She shared data comparing access to diabetes technologies in the United States and Germany. In the U.S., there’s been a precipitous decline in use of insulin pumps and continuous glucose monitors among populations in lower socioeconomic classes, while all socioeconomic classes use the technology equally in Germany, Dr. Addala said.
Learning the technology can also be a barrier to use, so Dr. Addala recommended that clinicians and health care systems provide highly visual, hands-on technology education through workshops, videos, and demonstrations. She also recommended peer-to-peer support groups.
“Localizing where disparities exist is actually quite simple,” Dr. Addala said. “You have to have an efficacious treatment and you have to have inequitable access. Where those two things collide is really where disparities tend to sit. And I will tell you that it really typically occurs as cutting-edge technology is innovating and the newest therapies are coming out.”