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The sales declines come even as the number of diabetes cases grows, fueled by the rise in obesity. According to the American Diabetes Association, more than 24 million Americans have diabetes.
Even as sales of expensive pills have fallen, sales of advanced insulin injections are up 9 percent since summer. That could mean some patients would rather face a needle to save money, according to Brian Lasky, a research analyst at IMS Health.
"By December, people were making decisions in terms of, 'Do I fill this prescription or ... buy Christmas presents for my kids?'" Lasky added.
Johnson & Johnson, a maker of top-selling OneTouch blood sugar meters, testing strips and insulin pumps, reported a 2 percent fourth-quarter drop in U.S. sales for the category compared with the same period a year earlier, a large drop considering quarterly sales up to then had been rising at around 10 percent.
"We're seeing some signs that consumers and patients are becoming more frugal," J&J Chief Executive Bill Weldon told analysts in January.
Getting patients to stick to their treatment has long been tough. But rising unemployment has made things worse.
At a family clinic in impoverished Newark, N.J., so many patients simply stopped showing up after losing health insurance that doctors posted notices asking clients with financial troubles to speak up so staff can try to help.
"Sometimes you don't see (diabetes) patients for several months," said Dr. Cynthia Paige, medical director of the New Jersey Family Practice Center. They "don't understand what a nightmare uncontrolled diabetes is and how it's ravaging your body," she said.
April Bumpus, 31, of Woodstock, Ga., was laid off from her job in medical sales last spring while recovering from surgery, and her health insurance was canceled. By September, she had to switch from two advanced insulins that tightly controlled her blood sugar to cheaper, older ones that cause surges and drops. The advanced insulin would have cost $360 a month, the older insulin only $100.
"It makes you really feel like you have the flu" at least once a week, said Bumpus, who's more worried about the long-term consequences. "That does scare me. I can have a heart attack, I can have a stroke, I can go blind."
Emergency rooms increasingly are treating diabetics who haven't been taking medicines, according to doctors at several hospitals nationwide and the professional group for ER doctors. Many of the patients have blood sugar so high they are hospitalized for days. Free clinics also are getting a surge of diabetes patients desperate for help.
"There's an increase in just overall consequences of diabetes: losing a foot, losing a kidney, bad eyesight. At least six people come to mind over the last six months ... most because of the recession," said Dr. Nicholas Vasquez, who works in one of the country's biggest ERs, at St. Joseph's Hospital in Phoenix.
Vasquez and his colleagues view the desperate patients in their ER as harbingers of what's to come if the recession deepens.
"What we're seeing mostly is the first steps of people not taking care of their diabetes and starting to have consequences," he said.
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