Last week when I went to the diabetes clinic expecting to be scolded for my numbers, the nutritionist told me jokingly that they only beat patients with an A1c of over 8%. The idea of punishing people for their blood test results might be a funny idea, but one you would expect to hear of in a Monty Python skit (yes, I guess I’m old), not read about in the news.
Apparently, though, the Hungarian health authorities think otherwise and have decided to try to reduce the growing healthcare spending on diabetes by punishing those who “fail” their A1c tests. Starting in July diabetes patients who do not achieve desirable levels on their blood tests (on 2 out of 4 tests a year) will no longer be prescribed analog insulin and instead will be given less efficient human insulin. (This announcement comes on the heels of the ADA’s announcement that there is no A1c number that’s right for everyone.)
Although there is no mention of types of diabetics who will be punished, it is safe to assume the new decree is part of the battle against the type 2 diabetes epidemic, and does not include type 1’s, although I am not certain of this.
According to the report, there are 500,000 people with diabetes in Hungary (out of a population of a little under 10 million), who cost the country an approximate 131 million dollars a year in healthcare costs.
The rational behind the new decree is that “Taxpayers’ money should not be spent on patients who don’t cooperate with their doctor.” According to the article a large majority of people with diabetes in Hungary are Hungry (sorry I just had to): only 30% of patients comply with the diet prescribed to them.
This of course is not surprising since the diabetes epidemic is part of the obesity epidemic plaguing the globe. The idea, though, that punishing people for overeating is going to do any good is totally ridiculous. As if anyone has ever stopped someone from eating, smoking or drinking by punishing him… But even more ridiculous is the idea that giving a patient a less effective insulin is punishing anyone but the healthcare system itself that will have to deal with the expense of complications later.
This is an outrage! First, it is well established that there is a disconnect between blood sugar control and complications, with many long-term diabetes survivors having very high blood glucose levels. Second, the patient’s ability to control blood glucose depends on a number of factors over which the patient has no control, such as gastroparesis, hypoglycemia insensivity, type 1 or type 2 diabetes, and residual beta cell function. Third, it has been demonstrated that efforts to achieve strict blood sugar control triple the number of severe, potentially life-threatening incidents of hypoglycemia, which the patient is quite sensible to avoid, and… Read more »
great article“` very current info needed for all of us
@L The problem here is that the people don’t actually feel the punishment until much later in life. If peoples insurance rates went up because of bad test results then maybe you would see a behavioral change but getting a less effective drug which makes it even harder to control diabetes is not going to change behavior in people who don’t care, don’t try hard enough or don’t know enough.
It’s not random: an entire field called behavioral economics is devoted to different ways to tax people (figuratively and literally) for undesirable behaviors and reward them for desirable behaviors. I imagine the Hungarians did some research before implementing this program. Time will tell if the diabetes rate in Hungary declines after these changed are instituted.