Recognizing that the costs for diabetic treatment interventions continue to escalate, with prices specifically for the newer analogue insulin among the most expensive, interest in exploring the role of lower cost human insulin as an effective alternative treatment for patients diagnosed with type 2 diabetes (T2DM) is growing. A study featured in January 2019 in JAMA describes a potential cost-savings solution achieved by implementing a switch to less costly human insulin while maintaining adequate blood-glucose control.

Corresponding and lead author Jing Luo, MD, MPH, affiliated with Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, and his team explored the association between glycemic control and switching to human insulin after use of the more expensive insulin analogue products.

In order to evaluate the impact of this medication switch, the team conducted a retrospective cohort study that analyzed 14,635 members enrolled in a Medicare Advantage prescription drug plan that was available in four states over the 3-year study period. The cohort included individuals with a mean age of 72.5 (standard deviation [SD] 9.8) years who filled 221,866 prescriptions for insulin. The mean A1C was 8.46% (95% CI, 8.40%-8.52%) at baseline, and there was a statistically significant overall A1C increase of 0.14% (95% CI, 0.05%-0.23%; P = .003) reported after the start of the switch intervention.

Following the switch intervention, however, there were no significant changes in mean A1C compared with the intervention period (P = .09 and P = .81, respectively). There was also no significant association between the start of the intervention and serious hypoglycemic events.

The authors noted that although there was an initial statistically significant increase in A1C, this change might not be clinically meaningful since a change of +/- 0.14% falls within the accepted biological variation of current A1C measures. Moreover, results from large randomized trials, such as ACCORD, ADVANCE, and VADT, support the finding that small changes in A1C are not likely to influence mortality rates or macrovascular events in patients with T2DM.  

According to the authors, “Because the least expensive versions of human insulin can be obtained at approximately one-tenth of the cost of analogue insulin, if even a small proportion of Medicare beneficiaries with type 2 diabetes who were prescribed analogue insulin were switched to clinically equivalent human insulin, the resulting savings to the health care system would
be substantial.”
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