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(Reuters Health) – Diabetes medications and blood-test supplies are sold, traded and donated on black markets because the U.S. healthcare system isn’t meeting patients’ needs, a study shows.

In a survey, about half of people who participated in these underground exchanges said they do it because they lack access to the proper medications and supplies to manage their diabetes, researchers report in the Journal of Diabetes Science and Technology.

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“It is important for healthcare providers and policymakers to understand what people are doing to support diabetes management when faced with medication and supply access issues,” said study leader Michelle Litchman of the University of Utah College of Nursing in Salt Lake City.

The price of insulin continues to increase, translating to $15 per day for the average user, the study authors note. Recent research indicates that one in four people with diabetes ration their insulin due to cost, they add.