Waikato University Study Shows Pharmac Diabetes Funding Saved Lives, Warns Against Proposed Reversal

A once-controversial decision to prioritise access to a type 2 diabetes medication for Māori and Pacific people is now showing clear life-saving benefits, new University of Waikato research reveals.

The findings come as Pharmac consults on proposed changes to funded access to diabetes medications, including reversing criteria that removed barriers for Māori and Pacific peoples to access lifesaving treatment.

Māori health leaders and Iwi-Māori partnership boards have warned the move could reverse gains in health equity for communities disproportionately affected by diabetes and its complications.

The study, led by University of Waikato Dr Lynne Chepulis, found that sodium-glucose co-transporter 2 (SGLT2) inhibitors deliver a greater reduction in risk of death for Māori and Pacific communities.

Pharmac funded the drug in 2021 with prioritised access for Māori and Pacific peoples – a move that attracted considerable debate at the time, but Dr Chepulis says recent findings show that decision appears to be making a meaningful difference.

“Because Māori and Pacific peoples are more affected by diabetes, often dying earlier, Pharmac initially made it easier for Māori and Pacific peoples to access this medicine. We wanted to test whether that decision made a difference,” Dr Chepulis says.

“The survival benefit was seen across most ethnic groups, but Māori and Pacific peoples experienced the largest reduction in risk of death.”

Dr Chepulis says the research highlights the importance of an equity-focused approach to healthcare.

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“This research shows targeted access policies can save lives, particularly for populations carrying the greatest burden of diabetes complications and premature mortality. In a perfect world, everyone who could benefit would have access to these medicines.

“For Māori and Pacific people, access to these medicines has been made simpler. They don’t have to jump through the same clinical hoops, which removes barriers and allows earlier treatment.”

The research analysed health data from nearly 60,000 adults with type 2 diabetes in the Auckland and Waikato regions, comparing people taking SGLT2 with similar people who were not. Researchers followed these groups over subsequent years to see whether the medication reduced the risk of death.

Diabetes remains one of New Zealand’s largest and fastest-growing health challenges. Ministry of Health figures show more than 348,000 people are living with diabetes, and the condition accounts for an estimated 11 percent of the country’s annual health budget.

Mortality rates for Māori with type 2 diabetes are at least twice as high than non-Māori, and it is predicted that one in four Pacific people will have the disease within 20 years.

The study also found that the survival benefits for Māori and Pacific people with diabetes were present regardless of whether they already had serious cardiovascular or kidney disease. This suggests the medication is effective not only for those who are already very unwell, but also earlier in the disease, helping to prevent future complications and premature deaths.

“SGLT2 inhibitors are game changing medications; they lower blood glucose levels, cardiovascular and kidney disease. By reducing those risks, they also reduce the likelihood of somebody dying,” she says.

University of Waikato co-author Dr Ryan Paul, co-chair of Mahitahi Matehuka (National Diabetes Network) and Clinical Director of the Waikato Diabetes Service, says it was widely welcomed when Pharmac removed barriers to access in 2021 following advice from the medical community.

“This study shows how effective that decision was in achieving equitable outcomes for all New Zealanders with diabetes,” Dr Paul says.

“Pharmac’s proposal to reverse their decision contradicts the evidence, specialist opinion, and our desire for precision medicine. New Zealand cannot afford to return to a time when Māori and Pacific people with diabetes died at least seven years earlier than their peers and diabetes complications costs the $1.68 billion every year.”

Dr Paul says SGLT2 inhibitors are highly cost-effective medications that can reduce heart attacks, strokes, amputations, heart failure and end-stage kidney disease.

“They have been available for over 15 years and considered standard care internationally for people with type 2 diabetes, but also in people with heart failure and kidney disease.”

He says Pharmac should instead consider widening access.

“Rather than the current divisive approach, Pharmac should be proposing funded SGLT2 inhibitors for all New Zealanders with type 2 diabetes, heart failure and/or renal disease.

“The evidence of benefit for hundreds of thousands of New Zealanders is overwhelming.”

The study, published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]), involved colleagues from the University’s Medical Research Centre and School of Computing and Mathematical Sciences, and partnership with Health New Zealand, University of Western Sydney, University of Auckland, Monash University, Midlands Health Network, and ProCare Health Limited.

NOTE: there is a current error in the legend titles in Figure 1 of this article. This is being amended and is expected to be available online in the next few days. The amended figure is also available from the authors.

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