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Are newer insulins always the better option?
1Diabetes Center of Excellence, University of Massachusetts Medical School, Worcester, USA.
Current Opinion in Endocrinology, Diabetes, and Obesity
|January 30, 2019
Summary
Newer insulin analogs are expensive without significant clinical benefits over older insulins. While they may slightly reduce hypoglycemia risk, especially in type 1 diabetes, cost-effective older insulins remain suitable for many type 2 diabetes patients.
Area of Science:
- Pharmacology
- Endocrinology
- Diabetes Management
Background:
- Insulin formulations have evolved significantly over the past century.
- Modern insulin analogs offer altered pharmacokinetic profiles for mealtime or basal coverage.
- These advanced insulins are considerably more expensive than traditional human insulins.
Purpose of the Study:
- To investigate the reasons behind the high cost of newer insulin analogs.
- To critically evaluate the clinical advantages supported by evidence for these newer insulins.
- To provide value-based recommendations for insulin prescribing.
Main Methods:
- Literature review and evidence synthesis.
- Comparative analysis of newer insulin analogs versus older human insulins.
- Cost-effectiveness evaluation.
Main Results:
- Manufacturing and development costs do not justify the elevated prices of newer insulin analogs.
- Newer analogs show no substantial improvement in achieving hemoglobin A1c goals compared to older insulins.
- A modest reduction in hypoglycemia risk is observed with newer analogs, particularly in type 1 diabetes patients.
Conclusions:
- The high cost of newer insulin analogs is not supported by their clinical efficacy or manufacturing expenses.
- For individuals with type 2 diabetes and low hypoglycemia risk, older insulins are safe and effective alternatives.
- Value-based prescribing should consider the modest benefits of newer analogs against their significant cost increase.
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