- Many patients with type 2 diabetes (T2D) currently using insulin analogs can be safely switched to less expensive human insulin.
Why this matters
- Insulin analogs have largely replaced human insulin for US patients with T2D.
- Retrospective study of 2015 Medicare Advantage plan-based intervention encouraging switching patients from analog to human insulin, including 14,635 members filling 221,866 insulin prescriptions during 2014-2016.
- Funding: Laura and John Arnold Foundation, Engelberg Foundation, Harvard-MIT Center for Regulatory Science, Brigham and Women’s Hospital.
- After intervention start, HbA1c increased 0.14% from baseline 8.46% (P=.003), but change was no longer significant at completion (P=.09).
- No significant differences in serious hypoglycemic events from preintervention to intervention (P=.41) or intervention to postintervention (P=.61); same for serious hyperglycemic events (P=.51 and .32, respectively).
- Total monthly analog insulin expenditures dropped from $2,226,389 on 1/1/2014 to $515,875 by 12/31/2016, whereas human insulin expenditures rose from $160,233 to $916,826.
- Proportions of patients reaching Medicare Part D coverage gap in 2014, 2015, and 2016 were 20.6%, 18.8%, and 11.1%, respectively.
- Possible residual confounding, time-related biases.
- Small HbA1c increase could become clinically significant for some individuals.
- Limited to claims data.
- May not generalize to other health care settings.