Real World Test

Kaiser Permanente tested if lower-cost human insulin would be effective for many patients with type 2 diabetes. They gave patients a financial incentive to change from analogue insulin to human insulin — $37.50 copay for analogue insulin versus no copay for human insulin.

The authors of this retrospective study compared patients who switched to human insulin (Humulin 70/30 or NPH insulin) injected twice daily with an equal number of similar patients who continued their analogue insulins injected three or more times per day.

The study period was 24 months from January 1, 2014, and December 31, 2016.

• A total of 14 635 older adults with type 2 diabetes were included in the study
• All participants were covered by a Medicare Advantage and prescription drug plan operating in 4 US states
• The average participant was 72.5 years old
• A total of 221,866 insulin prescriptions were fulfilled during the test period

Research Question

Would switching from analogue to human insulin change glycemic control among older adults with type 2 diabetes?

Research Methods

Mean HbA1c levels were checked over three 12-month periods:

• Pre-intervention (baseline) in 2014
• Intervention in 2015
• Postintervention in 2016

Secondary outcomes included rates of serious hypoglycemia or hyperglycemia using ICD-9-CM and ICD-10-CM diagnostic codes.

Results

The population of patients switching to human insulin saw an increase of 0.14% in their HbA1c which rose from a mean HbA1c of 8.46% to a mean HbA1c of 8.60%.  This increase was considered small by the study authors.

There was no significant change in the rate of serious hypoglycemic events between the two groups

Sources

Journal of American Medical Associations — https://jamanetwork.com/journals/jama/article-abstract/2722772

Harvard Health Blog — https://www.health.harvard.edu/blog/human-insulin-may-be-a-lower-cost-option-for-some-people-with-diabetes-2019060316747