Newer insulin treatments for diabetes — including insulin pens and insulin analogs — gained wider use in type 2 diabetes over a recent five-year period, according to a new study published in the journal JAMA Network Open.
Looking at data from 27.9 million doctor visits in the United States between 2016 and 2020, the researchers found several large changes in which insulin products were prescribed for people with type 2 over this five-year period. The data came from about 4,800 doctors each year, who each completed a form on two consecutive days documenting all of their patient visits — including basic demographic information, diagnoses (including diabetes type), and treatments. As part of this questionnaire, doctors were asked to document the specific insulin products that they prescribed or evaluated with their patients who had type 2 diabetes.
The researchers found that over the study period, Lantus or Basaglar (insulin glargine) was the most commonly prescribed insulin product, accounting for about half of all treatment-related doctor visits — including 2.6 million out of 4.9 million visits in 2020. This long-acting insulin analog (meaning its molecular structure is different from insulin produced by the human body) anchored the trend of long-acting insulins being the most widely prescribed, accounting for about two-thirds of all visits — including 3.7 million out of 4.9 million visits in 2020. The remainder of visits covered short- or rapid-acting mealtime insulin, which is less widely prescribed in people with type 2 diabetes.
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Increasing use of insulin analogs, pens
Analog insulins — both long- and short-acting — were the main types of insulin prescription bribed over the duration of the study, accounting for more than 80% of all prescriptions in all years. But even within this family of newer insulin types, there were changes in the type of insulin prescribed over the study period. In 2016, newer insulin types — those approved by the U.S. Food and Drug Administration (FDA) after 2010 — accounted for only 18.1% of all treatment visits, but this number increased to 40.9% of treatment visits in 2020.
When it came to insulin delivery devices, insulin pens accounted for 36.1% of visits in 2016 . This number increased to 58.7% of visits in 2020, and a corresponding drop was seen in the use of insulin vials and syringes as a means of insulin delivery. The total number of insulin-related doctor visits in the study dropped from 6.0 million in 2016 to 4.9 million in 2020 — a decline of about 18%, which may reflect the greater use of alternative treatments to insulin during this period. Many newer type 2 diabetes drugs — including some given by injection — have been found in recent studies to be highly effective at reducing blood glucose levels, without some of the risks linked to insulin injections such as hypoglycemia (low blood glucose). But the lower number of insulin-related visits in 2020 could also be related to the COVID-19 pandemic.
“This cross-sectional study found important patterns of insulin use in the United States, including the predominant use of insulin glargine, the persistently greater use of analog insulins, and the increasing use of newer insulins and pen devices,” the researchers concluded. “These findings are of broad relevance to patients, clinicians, and policy makers invested in improving access to and affordability of insulins in the United States.”