Patients with T2D fare well with less expensive insulin

  • Luo J & al.
  • JAMA
  • 29 Jan 2019

  • curated by Miriam Tucker
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.  

Limitations

  • 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.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit