The role of costs in diabetes management

Somia Iqtadar, MBBS, is an associate professor of medicine at King Edward Medical University, Pakistan, and chairperson of the Dengue Expert Advisory Group.

Should physicians inform their patients about the monthly cost of therapy before recommending a sodium-glucose cotransporter 2 (SGLT-2) inhibitor and ask them for permission to prescribe it? According to the guidelines (ADA 2023, ADA/EASD 2022, ADA/KDIGO 2022), these are the drugs of first choice for type 2 diabetes if the patient is diagnosed with chronic kidney disease or heart failure and the clinician is obliged to offer such treatment.

Somia Iqtadar, MBBS: Being a strong advocate of patient-centric and shared partner decision-making in diabetes management, I would say that it should be obligatory for the physician to inform the patient about the diabetes care management plan that he’s offering, and also to add the cost of treatment in it.

But at the same time, we need to understand that there are many pros and cons of antidiabetic agents like SGLT-2 inhibitors. We need to tell [the patient about] the advantages of these newer antidiabetic drugs, especially the role they have in cardiovascular protection, [the fact that] they are kidney friendly. We need to explain it to the patients because in the long run, this prevents them from many complications.

But in resource-limited settings, sometimes it is not possible for the patient to adhere to these medications because of the cost issue. I do not know whether we should be calling it adherence or affordability, but if you prescribe these drugs and the patient is unable to afford them, and they stop using them, then what is the point in prescribing these drugs?

I think it should be a shared decision between a physician and the patient, but [the patient] should be well informed about what the benefits are in the long term. And this small cost, which is an added problem for the patient at this certain [point in] time, may prevent many complications that can be more costly in the future.