A Gathering Storm

It’s always prudent to check the horizon for oncoming storm clouds. Sailors and aviators do it all the time. So should people with diabetes.

In our case as type 2s, there’s a gathering storm over how much other people will intervene in our lives as diabetes continues its epidemic ways in the western and developing world. As more and more public money comes to bear in the fight against diabetes, there will be an inevitable push to regulate diabetics’ behavior.

One of the first clouds in the oncoming tempest over this issue is the recent decision by the Hungarian government to deny access to more efficient—and also more expensive—forms of insulin to diabetics who fail to achieve their A1c targets. That country’s national health plan subsidizes the purchase of insulin among some 500,000 citizens (out of a population of 10 million) who have diabetes.

Under the government plan, which takes effect in July, people who fail twice in one year to reach their doctors’ recommended A1c goals will only receive treatment using human insulin. Human insulin is considered less effective than such modern insulin analogs as Humalog, Lantus, Levemir, and Novolog.

In Europe the recommended A1c target is 6.5%. In the United States, the American Diabetes Association recommended a 7.0% goal for years, but just recently issued new recommendations calling for people with diabetes to strive for below 7.0%.

However, in revising its recommendations, the ADA noted that the below-7.0% goal is one that only young and reasonably healthy patients should pursue. For older people who’ve had diabetes for years, and experienced hypoglycemic episodes along the way, the ADA recommends a more lenient A1c goal of 7.5% to 8.0%.

While A1c figures look straightforward, insisting that people reach certain ones—or else—opens a whole can of worms. Will Hungarian doctors take into detailed account each diabetic person’s physiology and health history? Will they tailor A1c goals to each individual, or be forced to follow a one-size-fits-all government dictate? Will some doctors succumb to a temptation to take bribes and fudge the figures they report to the people who control the purse strings?

While a majority of type 2s do not use insulin, there is always the long-range potential that we will. Whatever you think of the Hungarian government’s decision in terms of the control it wants to exert over its diabetic citizens’ lives, it seems almost inevitable. There is no such thing as an infinite economy or infinite resources, so when a government assumes responsibility for countering and treating a disease, it has to impose restrictions in the face of limited means. Hungary is a small foretaste of issues that will inevitably arise in larger countries like the United States, China, India, and Mexico.