June 27 (UPI) — Older versions of insulin for type 2 diabetics were just as effective as the newer, costlier generation of therapy in a recent study.
Researchers at the Yale School of Medicine and Kaiser Permanente studied the effects of human insulin and the newer analog drugs based on blood sugar totals and hospital and emergency department visits for hypoglycemia. They published their findings last week in the Journal of the American Medical Association.
Treatment of type 2 diabetes typically begins with a change in lifestyle and metformin, a low-cost pill lowering blood sugar levels. But up to 25 percent of diabetes patients eventually require additional insulin injections to control their blood sugar, the researchers note.
Both versions — the older Neutral Protamine Hagedorn and the newer Basal Insulin Analogs — can be prescribed as daily or twice-daily injections to control blood sugar throughout the day.
“For decades, people initiating insulin treatment were prescribed human insulin,” Dr. Andrew J. Karter, senior research scientist with the Kaiser Permanente Division of Research, said in a Yale press release. “Then in the 2000s, a new generation of long-acting insulin analogs emerged that were designed to mimic human insulin.”
And these new drugs are much costlier.
A vial of insulin analog costs about $200 to $300 compared with a $25 vial of NPH insulin, according to lead author Dr. Kasia J. Lipska, an assistant professor of medicine at Yale School of Medicine .
Analog insulin’s cost tripled nationally between 2002 and 2013, Lipska noted.
“We found that for patients with type 2 diabetes in usual practice, the use of the more expensive insulin analogs did not appear to result in better safety — at least as defined by hospital or emergency visits for hypoglycemia — or better blood sugar control compared with NPH insulin,” Lipska said. “This suggests that many people with type 2 diabetes should consider starting with NPH insulin, instead of insulin analogs, especially if cost is an issue for them.”
A retrospective observational study used data from 2006-15 of adults at least 19 years old from Kaiser Permanente of Northern California. In the study, 23,561 people started with NPH insulin and 1,928 began with analog insulin. Patients with type 1 diabetes were excluded.
Within one year of insulin initiation, hemoglobin A1c levels decreased by 1.27 percentage points among patients who started insulin analogs and by 1.43 percentage points among patients who started NPH insulin.
“Some people with type 2 diabetes may find the potential benefits of insulin analogs worth the additional cost,” Karter said. “But we found no population-level evidence to suggest that the extra expenditure is warranted for most people with type 2 diabetes, particularly when the high cost could prevent some of them from getting the treatment they need or divert resources away from other, potentially beneficial clinical interventions.”
They also said their research showed medications with high out-of-pocket costs are linked to poorer adherence, “which directly affects outcomes for diabetes patients.”