By Kristina Fiore,
Out-of-pocket costs for type 2 diabetes patients have risen with wider uptake of insulin analogs, researchers found.
In 2000, patients paid median out-of-pocket costs of $19 per prescription, which jumped to $36 in 2010, Kasia Lipska, MD, MHS, of Yale, and colleagues reported in a special theme issue on type 2 diabetes of the Journal of the American Medical Association.
During that time, use of human synthetic insulin dropped off (from 96% to 15%) while use of short- and long-acting analogs such as glargine, detemir, and aspart increased (from 19% to 92%).
But that change didn't appear to be associated with a significant benefit in deterring hypoglycemia, they found. There was only a small decline in the rate of hypoglycemic events between 2000 and 2010 -- 21.1 versus 17.7 events per 1,000 person-years.
"We found a large increase in the prevalent use of insulin analogs," they wrote. "The clinical value of this change is unclear."
Insulin analogs have gained widespread popularity: short-acting analogs for their flexibility in dosing and convenience, and long-acting analogs for their potential to diminish nocturnal hypoglycemia. But both of these cost more than the old staple of human synthetic insulin.
Sue Kirkman, MD, of the University of North Carolina in Chapel Hill, said that studies showing decreased hypoglycemia with insulin analogs in patients with type 2 diabetes have "had pretty weak results" and that main benefit has been slightly less nocturnal hypoglycemia.
"It's clear that the marketing for analogs has been very effective," Kirkman told MedPage Today. "Insulin companies have essentially stopped marketing human insulin."
But she noted that the authors couldn't track changes in the frequency of less severe hypoglycemic events, "which could still have a big impact on quality of life."
The data come from the Optum Labs Data Warehouse, an administrative claims database of privately insured enrollees.
The project was supported by a grant for the Agency for Healthcare Research and Quality.
The researchers reported relevant relationships with Medtronic, Johnson & Johnson, and Optum Labs.
Primary source: Journal of the American Medical Association
Source reference: Lipska KJ, et al "Use and out-of-pocket costs for insulin for type 2 diabetes mellitus from 2000 through 2010" JAMA 2014; 311(22): 2331-2333.