Diabetes is prone to heart and kidney comorbidities. The annual cost is 30 billion. Doctors call for relaxation of incretin benefits to "reduce the burden of health insurance"
The prevalence of diabetes and heart and kidney diseases cost nearly 100 billion in annual medical expenses
The diabetes population in Taiwan is increasing year by year, with the current prevalence rate approximately 11% and the number approaching 2.4 million. Diabetes has not only been ranked 4th-5th among the top ten causes of death in Taiwan for many years, but together with the major comorbidities chronic kidney disease and chronic ischemic heart disease, the total annual medical cost reaches nearly 100 billion yuan (chronic kidney disease 53.3 billion, 30.9 billion for diabetes and 12.2 billion for chronic ischemic heart disease). Proper treatment of diabetes is a major issue for the health and social costs of Taiwanese people.
Dr. Cai Shize, chairman of the Diabetes Care Foundation, pointed out that diabetes is closely related to cardiovascular disease and kidney disease. People with diabetes are more than twice as likely to develop coronary heart disease and heart failure, and more than 40% of the new kidney dialysis population in Taiwan is due to diabetes. , is the biggest cause of new kidney dialysis. Once diabetes progresses to end-stage renal disease, the risk of cardiovascular disease also increases.
For people with diabetes, cardiovascular disease is the leading cause of death, with about 50% of deaths attributable to cardiovascular disease. Dr. Cai Shize pointed out that only about 50% of diabetic patients are aware of their increased risk of cardiovascular disease, and diabetic patients are 2-4 times more likely to suffer from heart disease and stroke than the average person. In particular, stroke not only poses a life threat, but may also cause long-term disability and increase the burden on family care and society.
Diabetes treatment shifts to “organ protection” to help reduce medical expenses
Dr. Cai Shize emphasized that well-controlled diabetes can reduce the risk of large and small blood vessel diseases. Clinical studies have shown that if blood sugar can be controlled to reach the target, the occurrence of cardiovascular events will be significantly reduced. In recent years, the concept of diabetes treatment has paid more attention to “organ protection”. In particular, diabetics should pay attention to the prevention of heart and kidney diseases. For individuals, it can achieve blood sugar control and reduce complications and mortality; for society, it can help reduce the cost of medical treatment. expenses and reduce the burden of health insurance.
Dr. Cai Shize said that in the past five years, the consensus on diabetes care at home and abroad has been developing in the direction of cardiovascular and renal protection. It is recommended that groups at risk of comorbidities be given priority to use drug treatments that both control blood sugar and protect organs, such as enterocrine ( GLP-1 RA), combined with dietary adjustments and regular exercise, can help patients achieve good blood sugar control at different stages to reduce the risk of cardiovascular disease and kidney disease.
Enterocrine not only helps control blood sugar but also reduces the risk of heart and kidney comorbidities
Dr. Li Hongyuan, CEO of the Diabetes Care Foundation, said that people with diabetes face higher threats from cardiovascular disease and chronic kidney disease, and about one-quarter of the 30 billion annual care expenditure is for kidney dialysis. The proportion of chronic kidney disease among people with diabetes increased from 9.17% to 17.92%. Once blood sugar is poorly controlled, it will lead to premature arteriosclerosis, which may lead to complications such as stroke, cardiovascular disease, and heart failure.
Dr. Li Hongyuan pointed out that in recent years, diabetes treatment has shifted from simple blood sugar control to organ protection. The American Diabetes Association’s guidelines also state that patients’ risks of cardiovascular events, heart failure, and kidney disease should be given priority before selecting appropriate medications. Several large clinical trials have also shown that incretin (GLP-1 RA) can not only control blood sugar in diabetic patients, but also have a significant protective effect on reducing cardiorenal comorbidities.
Dr. Li Hongyuan explained that incretin is a protein secreted by the human intestine. The body secretes incretin after eating to promote insulin secretion and inhibit glucagon, thereby lowering blood sugar. In addition, enterocrine acts on the stomach and satiety center, making the body less likely to feel hungry, thus enabling weight control, making glycated hemoglobin more stable, and helping to reduce complications.
In addition, the time of treatment intervention also affects the disease control of diabetes. Data show that for diabetic patients with poorly controlled glycated hemoglobin (more than 7%), delaying treatment for one year will increase the risk of cardiovascular or peripheral vascular disease by more than 62%. Dr. Li Hongyuan pointed out that 61% of diabetic patients who received early intervention and active treatment could control their glycated hemoglobin to less than 7%, while only 37% received active treatment in the late stage. If patients who are suitable for enterocrine drugs can be treated early, they will be able to achieve better blood sugar control and prevent complications.
Enterocrine benefits in Taiwan are the strictest in the world? Doctors call for lowering standards to level in 3 years
However, the payment standards for enterocrine (GLP-1 RA) in health insurance are relatively strict, which may lead to the paradoxical situation that enterocrine is “visible but not used”. Dr. Li Hongyuan said that from 2019, health insurance regulations require that the glycated hemoglobin should be higher than 8.5% for more than six months after using front-line drugs, or diabetics who have experienced cardiovascular disease can be eligible for incretin benefits. Compared with Japan, South Korea, the United Kingdom, and Australia, Taiwan’s enterocrine payment standards are the strictest in the world.
However, clinicians usually replace drugs when drug control is not good, and will not allow diabetics to maintain 8.5% glycated hemoglobin for half a year. Dr. Li Hongyuan explained that glycated hemoglobin 8.5% is equivalent to blood sugar between 200 and 300 at any time, which is extremely poor blood sugar. Enterocrine has a protective effect on diabetic patients who have not experienced cardiovascular events, but it must meet the glycated hemoglobin level of 8.5% before it can be provided. Patients may still face the situation of not being able to use the drug.
Dr. Li Hongyuan said that the health insurance payment regulations are based on financial sustainability considerations. However, it can be seen from the proposed revision of the payment conditions for enterocrine (GLP-1 RA) put forward by the Diabetes Association that if the payment standard is revised down to glycated hemoglobin 7.5%, Although the drug expenses increased in the first two years, they will be evened out after the third year. Starting from the fourth year, it will help the National Health Insurance save more than 68 million in expenses. It is a good investment that takes into account both disease care and health insurance finances.
In view of the fact that enterocrine (GLP-1 RA) drugs have been clearly shown to help people with diabetes achieve blood sugar control, weight control, reduce the risk of cardiorenal comorbidities, and reduce disability and mortality, Dr. Li Hongyuan and patient groups called on the competent authorities Consideration should be given to relaxing the payment standards for incretin to help diabetic patients regain a healthy life and reduce the burden of health insurance in the long run.
Further reading:
