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A life saving class of diabetes oral medication, SGLT2 inhibitors, costing less than $3/day, is not covered in British Columbia, but is covered in the rest of Canada. I asked Dr. Elliott, Medical Director of BCDiabetes.ca for his comments. Dr. Elliott has already blogged twice on this class of medication (see https://www.bcdiabetes.ca/third-sglt2-inhibitor-in-canada/ & https://www.bcdiabetes.ca/empa-reg-outcome-renal/
Dr. Elliott’s comments:
The SGLT2 inhibitor class of oral diabetes medication has been available in Canada since July 2014. The class is represented by three very similar drugs: canagliflozin, dapagliflozin and empagliflozin. In the last two years these drugs have become firmly established as highly effective treatments for Type 2 diabetes. The drugs are more than twice as effective at lowering blood sugar than existing oral agents for Type 2 diabetes and importantly do not cause low blood sugar (hypoglycemia) or weight gain, a major problem with insulin (injected) and sulfonylurea medication (oral). SGLT2 inhibitors have the additional major benefit of leading to substantial weight loss (80% of individuals with Type 2 diabetes are overweight). SGLT2 inhibitors work by causing the kidney to waste sugar in the urine. This leads predictably to increased urine volumes and the desired effects of lower blood sugar & weight loss. Adverse effects include a three-times higher than usual risk of genital yeast infections, occasional kidney impairment and rare ketoacidosis.
SGLT2 inhibitors cost around $2.80 per day, or $100 per month including dispensing fees.
More than a year ago the EMPA-REG study was published providing powerful evidence for a 32% reduction in all-cause mortality for Type 2 diabetes patients at high risk (with a previous history of heart attack, bypass, angioplasty or stroke) with the use of the SGLT2 inhibitor empagliflozin. This magnitude of reduction in mortality risk for a medication is the highest seen in the entire breadth of medicine (excluding cancer) in the modern era, exceeding the 30% reduction in mortality seen with the use of the statin class of drugs in heart disease in the 1994 4S study.
Prior to the EMPA-REG study, SGLT2 inhibitors were “very nice to have” diabetes medications, that could be used safely and effectively by most of British Columbia’s 350,000 patients with Type 2 diabetes. In the wake of the EMPA-REG study, empagliflozin (and potentially the other two drugs in the same class canagliflozin and dapagliflozin, who have similarly designed studies soon to be published) became a “must-have” medication for the approximately 50,000 British Columbians with Type 2 diabetes at high risk.
All other Canadian provinces now cover one or more of the drugs in the SGLT2 inhibitor class. But not British Columbia. Yesterday I had a lengthy telephone call to discuss why this was the case with Dr. Eric Lun, Executive Director, Drug Intelligence & Optimization, Medical Beneficiaries and Pharmaceutical Services Division, BC Ministry of Health. Dr. Lun explained to me that the projected cost to the province, were the SGLT2 inhibitor class to be covered, would be $20M in the first year: these funds simply were not available with the recent budget freeze imposed on Pharmacare.
I hereby ask Dr. Lun’s boss, Health Minister Terry Lake, “can you afford not to offer this life-saving therapy to the 50,000 British Columbians at risk?”