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Out-of-Pocket Costs Way Up for Type 2 Diabetes

Study questions value of insulin analogs, but U.S. diabetes expert says they're cost-effective

WebMD News from HealthDay

By Dennis Thompson

HealthDay Reporter

TUESDAY, June 10, 2014 (HealthDay News) -- Laboratory-engineered "insulin analogs" have become the main type of insulin prescribed for people with type 2 diabetes, significantly boosting their out-of-pocket costs, a new study reports.

Insulin use among those with type 2 diabetes increased by about 50 percent over a 10-year period, with most patients receiving pricey insulin analogs that have nearly doubled the amount of money they pay for their prescriptions, said study author Dr. Kasia Lipska, an instructor in medicine at Yale University School of Medicine.

The analogs are molecularly altered forms of human insulin that are designed to be absorbed more quickly or more slowly by the body than human insulin, to avoid dangerous drops in blood sugar levels overnight or to help the body process meals quickly.

"We have made an almost universal transition to the use of the more expensive insulin agents, at least among privately insured patients," Lipska said. "Do all these patients find the potential benefits of analogs over human insulin worth the cost? Probably not."

But, Dr. Robert Ratner, chief scientific and medical officer of the American Diabetes Association, said the case could be made that increased use of insulin and insulin analogs shows that diabetics and their doctors are doing a better job controlling the chronic disease.

"The increase in the use of insulin over this time period is actually strongly correlated with other data that show improved glucose [blood sugar] control and decreases in complications, which is a very good thing," Ratner said.

Many people with type 2 diabetes take insulin to help process blood sugar. If blood sugar levels get too high, a wide range of health problems can set in, leading to damage to the heart, eyes, kidneys and nerves, and other organs.

On Tuesday, the federal government reported that the number of Americans with diabetes rose from 26 million in 2010 to 29 million in 2012 -- or 9 percent of the population. Between 90 percent and 95 percent of diabetes cases are the type 2 variety, according to the U.S. National Institutes of Health.

Lipska and her colleagues examined trends in insulin use using data from an administrative claims database of privately insured people from throughout the United States, but with more representation from states in the South and Midwest. The analysis included adults 18 years or older with at least two years of continuous insurance coverage between January 2000 and September 2010.

The researchers found that use of insulin among patients with type 2 diabetes increased from 10 percent in 2000 to 15 percent in 2010, a trend largely attributable to the widespread adoption of insulin analogs.

Among adults using insulin, 96.4 percent filled prescriptions for regular human synthetic insulin in 2000, while 18.9 percent received insulin analogs.

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