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The NHS could have saved a total of £625 million if it had prescribed NICE-recommended drugs for the treatment of type 2 diabetes as opposed to other treatment options, according to a new study NICE's guideline on type 2 diabetes recommends that human NPH insulin should be the first-line treatment offered to people with the condition.

It says that insulin analogue alternatives, which are laboratory-made, synthetic versions of human insulin, should only be used in certain specific circumstances, such as for patients whose lifestyle would be restricted by recurrent symptomatic hypoglycemic episodes.

However, a study published in BMJ Open, has found that NHS spending on insulin analogues rose from £18.2 million to £305 million between 2000 and 2009.

This compares with a decrease in the amount spent on human insulin from £131 million to £51 million during the same period.

The study found that if all patients using insulin analogues received human insulin instead, the NHS could have saved a total £625 million.

Lead author Professor Craig Currie, of the Department of Primary Care and Public Health at Cardiff University's School of Medicine, said: "The guidelines are quite specific, but they are not being paid attention to.

"The amount spent each year on insulin drugs is rising year-on-year, and reached its peak at 2009 (the last year examined in the study).

"If more people looked at the NICE guideline, a notable proportion of the total spend in the NHS would have been saved."

He added: "The system needs to be changed, and it needs to make sure that more doctors are using the guidelines."

NICE says that the first insulin treatment for type 2 diabetes should be a human NPH insulin injection at bedtime or twice daily according to need.

Alternative insulin analogue treatments (such as insulin detemir or insulin glargine) should only be given in particular circumstances. These are:

  • if they reduce the number of injections required in a person who needs assistance from a healthcare professional to inject insulin
  • if episodes of symptomatic hypoglaecemia restrict the person's lifestyle and the person would otherwise need twice-daily NPH insulin injections in combination with oral glucose-lowering drugs
  • or if the person cannot use the device to inject NPH insulin.

The study says patients might find the relative ease of administering insulin analogue drugs appealing, and that this could have contributed to the rise in their use.

It adds that this is supported by the fact that 40 per cent of analogue insulin was prescribed as a prefilled pen in comparison with 18 per cent of human insulin.

The study also suggests that the rise in insulin analogues, which tend to be more costly than human insulin options, could be "due in part to successful marketing". This is despite most experts believing they provide benefits which "are modest in comparison to human insulin".

Professor Currie continued: "Doctors are prescribing more insulin analogues because they are susceptible to pharmaceutical companies.

"The manufacturers are doing very well at their job of marketing their products."

The study does concede certain limitations in its findings, such as the assumption that all people using insulin analogues could be treated equally well with human insulin.

However, it quotes Dr Amanda Adler, Chair of the NICE Guideline Development Group for type 2 diabetes as saying that 90 per cent of type 2 diabetes patients could receive human insulin, and that two-thirds could remain on these drugs.

All of NICE's information on diabetes can be found in our online Pathways tool, which makes it easy to access the guideline itself and the supporting implementation tools in one location.

Source: NICE

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Written by Scott Buckler   
Monday, 26 September 2011 15:17


0 #1 Director of Care Information and AdvocacySimon O`Neill, Director of Care Information and Advocacy
Diabetes UK
While there is limited and inconclusive evidence that insulin analogues improve HbA1c, there is evidence that analogues have beneficial effects on glycaemic control by reducing postprandial glucose levels, improving fasting glucose levels, reducing hypoglycaemia (especially nocturnal) and reducing weight gain. It's important to note these benefits should not be seen as less important than reduction of HbA1c - these outcomes play an important part in improving quality of life of people with diabetes and must not be ignored.

"Diabetes UK recommends that insulin analogues, whether rapid acting, long acting or premixed should be as available as human insulin to all people with diabetes. The decision of which insulin is the most appropriate for a person with diabetes should be made on an individual basis in consultation with the person with diabetes themselves

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