Human intervention in diabetes

Switching patients with type 2 diabetes from insulin analogues to human insulin could save a lot of money without causing harm, new research suggests.

Findings were recently published from a US study of 14,635 participants who filled a total of 221,866 insulin prescriptions in 2014-2016.

The US study examined differences in glycemic control and costs over three years in a health plan-based intervention in which insulin-treated patients were encouraged to switch from analogue to human insulin.

Analogue insulin is a sub-group of human insulin that is laboratory grown but genetically altered to create a more rapid acting or more uniformly acting form of the insulin.

In the study, there was a small but statistically significant increase in HbA1c when using human insulin with no difference in the rates of severe hypoglycemia or hyperglycemia. At the same time, costs dropped considerably.

Yale School of Medicine’s Dr Kasia J. Lipska says analogues have largely replaced human insulin in patients with type 2 diabetes in the US, despite a lack of data that they provide significant benefit and have a 10-fold greater cost.

“These findings should prompt physicians and patients to reconsider which type of insulin is best,” she said. “Human insulin may not be the optimal choice for everyone, but it could be a solution for many patients with diabetes.

“On the individual patient level, use of human insulin may minimise out-of-pocket spending, and, on the healthcare system level, it may allow insurers to maximise the value of diabetes care.”

Ms Lipska cautions that not all patients will do well when switching to human insulin. This includes patients with type 1 diabetes or who may be at increased risk of hypoglycaemia.

“Any program designed to promote switching to human insulin should take individual patient needs into account and allow for flexibility with respect to the choice of insulin,” she said.