Type 2 diabetes mellitus (T2DM) affects almost 77 million Indians¹ and inflicts considerable health, mortality, and economic burden on patients and their families. The burden is not only due to diabetes per se but also its complications causing inevitable expenses for consultation, investigations, treatment, hospitalization, etc., among other indirect costs.

Cardiovascular diseases, including heart failure, are a major complication of T2DM that remarkably impact the quality of life of patients. Patients with T2DM have two to four times higher risk of developing adverse cardiovascular events, including coronary artery disease and heart failure (HF), compared to those without diabetes.²

The average monetary cost of heart care in private hospitals can amount to lakhs of rupees. Many people in India do not have a health insurance. Thus, the prevention of even one adverse event would prove to be cost-effective since the absence of insurance cover lays down the financial burden of treatment on the patients and their families.

There is no lack of effective diabetes management, as several effective anti-diabetics that also offer cardio-protection are available in the market. However, the question is about the affordability of these medications to the common man, whichhas remained a major barrier in prescription of SGLT2 inhibitors or gliflozins, namely dapagliflozin, canagliflozin, and empagliflozin. Gliflozins are a relatively new class of oral antidiabetics that have been demonstrated to impart significant cardioprotective benefits in patients with T2DM. Cardiovascular outcome trials have shown that SGLT2 inhibitors lead to a consistent reduction in cardiovascular mortality and hospitalization for heart failure (HF) among patients with type 2 diabetes.³ However, these antidiabetics, owing to their high cost, have faced clinical inertia, and have remained a class of drugs that failed to fit within a common man’s budget. Another SGLT2 inhibitor, remogliflozin, though cheaper than its counterparts, finds limited clinical application and preference owing to a scarcity of evidence supporting its benefits. Ultimately, the key is to balance the assured utility and evidence-based benefits against the price.

A wonderful development for patients and their healthcare providers now is that evidence packed diabetes care is available at approximately one-fourth of the price. Some dapagliflozin brands, which until last month had a monopoly in the market, have lost the exclusivity rights resulting in reduced daily treatment costs. The huge price reduction with the entry of generic players in the market is bound to significantly improve the face of diabetes care in India. A larger population with diabetes can now be brought within the frame of evidence-based therapeutic care. Dapagliflozin has also demonstrated reno-protective benefits and could help in tackling the burden of diabetes-related kidney disease along with the prevention of cardiovascular adverse events.

References

1. Saeedi P, Petersohn I, Salpea P,et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes Res Clin Pract. 2019 Nov 1;157:107843.
2. Gallwitz B. The Cardiovascular Benefits Associated with the Use of Sodium-Glucose Cotransporter 2 Inhibitors–Real-World Data. Eur Endocrinol. 2018 Apr;14(1):17.
3. Dos Santos DS, Polidoro JZ, Borges-Júnior FA, Girardi ACC. Cardioprotection conferred by sodium-glucose cotransporter 2 inhibitors: a renal proximal tubule perspective. Am J Physiol Cell Physiol. 2020 Feb 1;318(2):C328-C336.