New-generation diabetes drugs are set to be publicly funded - a breakthrough that could keep up to 120,000 New Zealanders in good health and alive longer.
Pharmac has announced it wants pharmaceutical companies to submit proposals for the supply of new medicines to help Kiwis battling type 2 diabetes.
A leading diabetes clinician says the drugs being considered are "life-changing and life-saving" - but Pharmac's proposal meant they would be used only for special cases or as add-ons to the existing poor standard of care.
"They must be funded for full open access, and as second and third line treatments," said Dr John Baker, chairman of the Diabetes Trust.
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About a quarter of a million Kiwis have diabetes, and another 100,000 are thought to be undiagnosed. Around 90 per cent have type 2, the sort mostly brought on by lifestyle and linked to obesity.
Pharmac's deputy medical director Dr Peter Murray said patients and clinicians had been asking for the new medicines to be funded.
"Evidence suggests these medicines do more than just reduce sugar levels in people with type 2 diabetes. They can also help address related complications like kidney and heart disease.
"We hope to fund at least one of these medicines by negotiating with medicine suppliers and running a competitive pricing process."
The new medicines are called SGLT-2 inhibitors, GLP-1 agonists and DPP-4 inhibitors. Pharmac has issued a request for proposals (RFP), something done when more than one medicine is available to treat a condition, such as when there are multiple brands or when different medicines have a similar therapeutic effect. The process could take several months.
It comes after an ongoing Herald investigation into the growing toll of diabetes, with amputations now topping 1000 every year as clinicians and patients struggle with the worst range of funded diabetes drugs in the developed world.
Responding to those findings in October last year, Associate Health Minister Peeni Henare revealed talks with Pharmac about funding better drugs, and said he personally supported tough measures including a sugar tax and warning labels on junk food (a sugar tax has been ruled out by the Prime Minister).
Last night, Henare said Pharmac's announcement was "a positive step in the right direction" and the medicines had the potential to benefit about 120,000 New Zealanders living with type 2 diabetes and at risk of further complications.
"The number of New Zealanders with diabetes is growing and the burden of this disease disproportionately falls on people living in deprived communities, as well as Māori, Pacific and Indian people," Henare said.
"A wide range of tools and approaches are needed, including prevention - lifestyle changes, diet, physical activity, and early intervention to turn this tide."
Baker, who as well as chairing the Diabetes Trust is a specialist at Middlemore Hospital, said the medicines were the first of a new generation of drugs that reduce cardiovascular deaths and progression to renal failure.
"Currently funded medications do not do this. The new drugs are also associated with lower incidence of side effects. They cause weight loss - rather than weight gain - and they do not cause hypoglycaemia [low blood sugar]. Combined with being relatively cheap and easy to use, these drugs are life-changing and life-saving."
However, Baker said Pharmac's proposal was "devastating" because it would only allow the medicines to be used rarely and in addition to the current standard of care, which international diabetes associations had deemed third world.
"Pharmac should be under no illusion - after 20 years of waiting, clinicians will not accept an outcome where these medicines are funded only for special cases or only as adjuncts to the existing poor standard. They must be funded for full open access, and as second and third line treatments."
Heather Verry, chief executive of Diabetes New Zealand, which has petitioned for the funding of some of the medicines, supported that message.
She said the drugs that could soon be funded would make a significant difference for patients, and help them avoid the worst complications of diabetes, which would provide a massive whole-of-Government saving.
"They are a really good, modern drug, which is what we have been needing for a long time...both of them are a weight management assistance tool as well, which is one of the things people need to do to try and reverse their diabetes.
"It will help a lot of people to put off, delay or stop complications from happening. One of the risks is cardiovascular, another is kidney disease - 52 per cent of people with kidney disease is due to people with diabetes - and then you have lower limb amputations, and blindness."
Diabetes happens when the pancreas stops making enough insulin, or insulin can't be properly used. Without insulin, glucose (sugar) from food cannot get from the bloodstream into cells to produce energy.
Over the long term, too much glucose in the blood ravages nerves, organs and tissue, risking heart attack, stroke, amputation, kidney failure and blindness.
Controlling blood sugar levels greatly reduces the chance of complications, and can slow or stop illness that's already taken hold. That can be done through medication, insulin injections, and by improving diet and exercise levels.