• Archives

  • Aug9

    Do Statins Raise Diabetes Risk?

    Posted in: Aging and Costs of Aging, Diabetes, High Cholesterol, Vitamins and Supplements, Wellness and Health

    Probably, in higher doses.

    A study of 18000 people without heart disease, called JUPITER, shows that Crestor (rosuvastatin) 20 mg showed that for every 1000 patients on high dose (40mg and up) statins, there are 6 more cases of new diabetes over 2 years.

    Crestor also prevented 11 cases of heart attack, stroke, arterial revascularization, hospitalization or death from heart disease, in that 1000 patients.

    The newest study includes 32,752 patients without heart disease.  Again, 2 cases of diabetes, versus 6 or more cardiac events prevented in a 1000 people over 5 years.

    If you actually have heart disease or angina, then the numbers for taking a statin are different.

    • 1 in 83 life saved
    • 1 in 39 prevented a non-fatal heart attack
    • 1 in 125 prevented stroke
    • 1 in 167 developed diabetes

    Is that worth the trade-off?

    I try to find ways for my own patients to get off high doses of statins, especially 80mg doses, because of myopathy and pain.

    A cholesterol registry can chronicle how people control cholesterol naturally.

    I suggest that any patient 40 and over get screened every 3 years, and make sure they don’t suffer from abnormal lab test syndrome.  And I help them make lifestyle changes that help them reduce their need for cholesterol medication.

    Statins can be important medications, and their benefits can be greater in diabetics than nondiabetics.

    But there’s no sense in tempting fate. Let’s enjoy life, and avoid getting diabetes in the first place. Lower your cholesterol with what you eat.

     

  • Mar1

    Diabetes Doubles! Food Can Help. Should It Be Reimbursed?

    Posted in: Aging and Costs of Aging, Diabetes, Wellness and Health

    Americans treated for diabetes doubled to about 19 million (8.5% of the population) in 2007 compared with 9.1 million (4.6% of the population) in 1996, according to the AHRQ, a federal agency.

    That doesn’t count the undiagnosed (7 million) and those with prediabetes (79 million).

    Health care spending on diabetes more than doubled to $40.8 billion (the ADA says this figure is low: total diabetes costs are $174 billion, they say, in 2007). U.S. Diabetes expenses 1996-2007

    But something odd happened: what it was spent on changed.

    The amount spent on on prescription medication in 2007 doubled vs 1996: 46.7% compared with 23%.  The amount spent on home health actually fell by nearly two-thirds: 9.5% vs 27.1%.

    Individuals with diabetes paid double too: $1048 in 2007 versus $495 in 1996.

    What do all these numbers mean? They mean diabetes is doubling, fast. They mean that payers are paying for medication–not home care, by a mile.  Actually, by billions of dollars.

    But I wonder if these same payers know the data about lifestyle program cost and prevention of diabetes.Diabetes Prevention Program

    This slide summarizes the results of the Diabetes Prevention Program. It tested metformin (a good, inexpensive medication)  versus diet and lifestyle in reducing diabetes, for a year.  Metformin reduced diabetes by 31%.

    Lifestyle did better. It reduced diabetes by 58%. Without any complications.

    They lost just 7 percent of body weight and exercised only 2.5 hours weekly, on average.

    It was an expensive program–about as expensive as medication, not including diabetes costs prevented–but the researchers brought the costs down: United Health is testing a version with the YMCA and pharmacists.

    More innovation! That’s the spirit! Should the right food be reimbursed?

     

  • Sep9

    No Meds Rx II: Hidden Money

    Posted in: Aging and Costs of Aging, High Cholesterol, Wellness and Health

    Last week I covered common reasons people stop taking their medications: reminders, financial/physical barriers, and poor communication.  This week, money.

    But saving real money appears to be with reminders (last week) and communication (next week).

    Even bigger money? Small lifestyle changes that let you avoid the need for medication, or reduce your dependence on it. But then, that’s what ChefMD and is about. And so are Medifocus books on diabetes, high cholesterol, and reflux.

    Medication samples are ostensibly for checking side effects before investing in a full prescription.

    But in practice they are often used for people who cannot afford any medicine. And when they run out (only new meds are usually sampled), the medically indigent are out of luck.

    Fortunately, these sites are patient assistance programs:

    • needymeds.com (brand name and generic discounts)
    • rxassist.org (many options)
    • pparx.com (brand names)
    • rxhope.com (online apps)
    • togetherrxaccess.com (brand name and generic discounts)
    • accesstobenefits.org (Medicare beneficiaries)

    The latter site offers enrollment for Medicare Rx Extra Help, as does benefitscheckup.org.

    In addition, major pharma groups (AZ, GSK, Lilly, Merck and Pfizer) have medication discount programs: AZ, Merck and Pfizer’s programs cover all uninsured individuals; Lilly covers Medicare Part D individuals only; GSK has programs that cover both.

     

  • Sep3

    No Meds Rx: Why People Stop Taking Medications

    Posted in: Drug Food Safety, Vitamins and Supplements

    Why people stop taking their prescribed medications is really important, because everyone loses.

    The patient and her family lose the needed medical effect. The clinician and clinic lose a tool. Employer and health insurance company lose an employee’s health and dollars. Pharma company loses continuity and a customer.

    Reasons fall into 3 categories: reminders; financial/physical; and communication. Today, just reminders. Next week, money.

    Many clinicians miss the chance to simplify dosing. Adding another med to an existing regime is what we are trained to do…not minimize.

    Most doctors are taught in school to think twice before prescribing a combo product–those with two medicines combined–because the action is hard to trace. Yet, doing just that can help patients remember to take their one medicine, instead of two.

    I’ve recommended pill boxes, which are cheap and effective. Pill reminders now come in free phone Apps, but post-its can help. Putting your pills by your toothbrush or site of another daily activity can help.

    The older term for not taking meds, is noncompliance: I’m even on record in the Hastings Center Report using it. The newer, more accepted term is “patient adherence”: patient as partner is closer to what will help most.

     

  • Oct27

    Weight Gain from Medication: Reversible? or Inevitable?

    Posted in: Obesity and Weight Loss

    One of the most vexing things about trying to lose weight is your mood. In the beginning, my (adult) patients can be a little grouchy, even if they are losing pounds, not flavor, using culinary medicine.

    Even if they’re depressed, anxious, schizophrenic or bipolar and on prescription medication. And especially if their weight gain is from their medicine.

    Newer medicines like Seroquel, Abilify, Zyprexa and Risperadal are promoted because they have fewer medical side effects, like tardive dyskinesia, than older psychiatric medicines. And they do.

    But these newer medicines also have a higher cardiac risk than the older ones, and the leading cause of death in the mentally ill is heart disease.

    And the new medicines don’t have less weight gain for kids, as has long been known for adults.

    A recent JAMA report studied 255 students taking the drugs: they gained between 8-15% of their body weight in about 12 weeks…between 1 and 1.5# per week.

    The Biggest Gainer? Zyprexa. :(

    In adults, the superiority of these “atypical antipsychotics” over traditional ones for schizophrenia is debated, but the need for all adults to be a healthy weight is not.

    What to do?

    When I did an online forum with dr-bob.org on obesity from psych medication in 2003, the response was overwhelmingly interested and eager. These people really need help.And deserve it.

    It turns out that many of the same strategies and tactics help them as help other people keep weight off once they lose it.

    My favorite are these 4, from the National Weight Control Registry:

    “78% eat breakfast every day.

    75% weigh them self at least once a week.

    62% watch less than 10 hours of TV per week.

    90% exercise, on average, about 1 hour per day.”

    The bottom line? Don’t stop taking your medication. Find a clinician and trainer you can work with for a fitness program. Work with them. Keep at it.

    If your child is being treated for a mental illness, ask your psychiatrist if there are alternative therapies you can try: the long term risks are substantial.

    You can succeed if you plan, and if you believe. Even if it doesn’t seem like it, you can!
    John La Puma, MD