VOLUME 10 NUMBER 1 • MARCH 2013
7
SA JOURNAL OF DIABETES & VASCULAR DISEASE
FUNDING DIABETES CARE
Correspondence to: Dr Landi Lombard
Netcare Kuils River Hospital, Cape Town
Tel: +27 0(21) 900-6350
e-mail:
S Afr J Diabetes Vasc Dis
2013;
10
: 7–8
T
here is currently a worldwide pandemic of type 2 diabetes
that is spiralling out of control and threatening to overwhelm
healthcare systems. South Africa is no exception, and the
escalating incidence of obesity here suggests that it will get worse.
The brunt of this pandemic will have to be managed at a primary-
care level where general practitioners and primary-care nurses will
play a vital role.
Healthcare professionals work under huge pressure to
accommodate all their patients. We try to manage these patients
optimally, taking into account efficacy, side effects and cost. At
the specialist level, each drug is carefully selected according to
individual characteristics and needs.
However healthcare funders make it difficult for us by each having
their own set of rules and recommended drugs, which change
periodically. They also show little insight into the variety of options
available to diabetics and only consider the cheapest options. If we
don’t address this, we might soon find ourselves only generating
an ICD-10 code and the funders will decide which medicine will
be allowed. This is causing huge frustration in daily practice and
contributing to the emigration of many of our doctors.
National and international guidelines are published, drawn up
by the best and most knowledgeable people in the world. The
funders seem to ignore these and have their own ‘experts’ draw
up their guidelines. In my opinion this should not be allowed by
the Council for Medical Schemes. The national guidelines should
be enforced by law.
The other side of the coin unfortunately is that with the marked
increase in incidence of diabetes, there is also a dramatic increase
in cost for the funders. Medical aid premiums are also increasing at
an alarming rate and soon most people will not be able to afford
them. Physicians must be cost effective, but not at the cost of
efficacy or side effects.
I am of the opinion that we should manage chronic illness at
the optimum level to prevent complications down the line. Money
could be saved on expensive procedures if a national guideline could
be drawn up to regulate the implementation of these procedures,
for example, chronic haemodialysis, cardiac defibrillators, TAVIs,
ventilation withdrawal protocols, and admissions for diabetes. All
medical aids should have to cover the same benefits.
Table 1 shows the drugs currently registered with the Food and
Drug Administration, as well as their availability in South Africa.
1
We
Medical management of type 2 diabetes mellitus:
a frustrating battle with the funders
LANDI LOMBARD
Table 1.
Drugs currently registered with the FDA as well as their availability in
South Africa.
1
Brand name
Generic name
Approval date Yes/no
ACTOplus met
pioglitazone hydrochlo-
ride and metformin
hydrochloride
August 2005
N
Apidra
insulin glulisine
February 2004
Y
Avandamet
rosiglitazone maleate
and metformin HCl
October 2002
N
Bydureon
exenatide synthetic
January 2012
N
Byetta
exenatide
April 2005
Y
Humalog
insulin lispro
June 1996
Y
Humalog 50/50 50% insulin lispro pro-
tamine and 50% insulin
lispro
June 1996
Y
Humalog 75/25 75% insulin lispro pro-
tamine and 25% insulin
lispro
December 1999
N
Humulin N
NPH (N)
October 1982
Y
Humulin 70/30 70% NPH and 30%
regular
April 1989
Y
Humulin R 100 U regular (R) Insulin
October 1982
Y
Humulin R 500 U regular (R) Insulin (5
times concentration)
October 1982
N
Janumet
sitagliptin/metformin
HCl
March 2007
Y
Janumet XR
sitagliptin and met-
formin HCl extended-
release
February 2012
N
Januvia
sitagliptin phosphate October 2006
Y
Jantadueto
linagliptin plus met-
formin hydrochloride
February 2012
N
Juvisync
sitagliptin and simvas-
tatin
October 2011
N
Kombiglyze XR saxagliptin/metformin
hydrochloride extended
release
November 2010
N
Lantus
insulin glargine
April 2000
Y
Levemir
insulin detemir
June 2005
Y
Lucentis
ranibizumab
August 2012
N
Metaglip
glipizide/metformin HCl
October 2002
N
Novolin N
NPH (N)
July 1991
Y
Novolin R
regular (R)
June 1991
Y
Novolin 70/30
70% NPH and 30%
regular
June 1991
Y
Novolog
Insulin aspart
November 2001
Y
Novolog 70/30 70% insulin aspart
protamine and 30%
insulin aspart
November 2001
Y
Onglyza
saxagliptin
July 2009
Y
PrandiMet
repaglinide/metformin
hydrochloride
June 2008
N
Symlin
pramlintide
March 2005
N
Tradjenta
linagliptin
May 2011
N
Victoza
liraglutide
January 2010
Y
Welchol
colesevelam hydro-
chloride
January 2008
N
