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july/august 2008

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In the late summer and fall of 2007, VVA put together a white paper on the VA formulary, and circulated it on Capitol Hill and elsewhere. Among other things, it showed that the VA pharmaceutical formulary was much more restrictive than either DoD or Medicare regarding new treatment medicines for control of diabetes. We said that the VA was again being “penny wise and pound foolish” because the so-called “savings they made by effectively denying veterans and their clinicians access to the best pharmaceuticals available were miniscule in comparison to the expense of the damage done by diabetes being not as well controlled and the damage done by the resulting secondary conditions, both of which meant many more very expensive acute care hospitalizations.”

Sen. Daniel Akaka (D-Hawaii) wrote to the Undersecretary for Health regarding this issue. The VA’s reply was that there was no problem, that they were “the world class” leaders in treating diabetes, even though the evidence made it clear that this was not the case. As usual, the VA maintained that it knew more than anyone else, including DoD, the Medicare people, the American Diabetes Association, and certainly more than veterans’ advocates.

After waiting for five months, in March 2008 the Veterans Health Administration quietly added the therapeutic category “long-acting insulin” to the VA National Formulary. “This is a significant victory for veterans with diabetes,” said VVA President John Rowan. “The addition to the VA formulary of newer therapeutic categories of drugs such as long-acting insulin brings the VA closer into agreement with treatment for diabetes in the rest of the country. This is a very positive action that we have long advocated for.”

Of the approximately 5.5 million veterans who receive VA health care services, some 20 percent, or 1,020,000, are diabetics. By comparison, the American Diabetes Association estimates that some 7 percent of the American population has diagnosed or undiagnosed diabetes. The VA prevalence of diabetes can be attributed to the average age of the veteran population (62), the predominance of men (97 percent), and a higher rate of smoking than the general population.

A recent study by the VA Pharmacy and Therapeutics Society on the implementation of new insulin glargine for patients with diabetes revealed significant differences in implementation between VA regions and treatment facilities, as well as problems with the adoption of new therapies and the VA’s formulary process, and the use of insulin glargine in the VA. The addition of long-acting insulin to the National Formulary should improve care across the VA system.

The evidence is overwhelming that sub-optimal diabetes care results in drastically increased costs, as well as poorer quality of life and worse clinical outcomes, such as blindness, cardiovascular diseases, amputations, and kidney problems.

The benefit of long-acting insulin to help control blood-glucose levels is that the patient generally does not have to take as much insulin or as often. The patient has to monitor blood sugar levels less often and has to take insulin less often. Fewer needle sticks means better patient comfort and compliance. Better blood-glucose control leads to fewer adverse complications and a better quality of life.

Patients with diabetes or those who believe they have diabetes should consult with their physicians. The conditions that lead to diabetes include being overweight, hypertension, raised cholesterol and lipids levels, and smoking. The characteristic symptoms of diabetes are excessive urine production, excessive thirst, increased fluid intake, blurred vision, unexplained weight loss, and lethargy.



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