Two new studies explore this relatively recent diabetes prescribing trend.
In one study, use of newer noninsulin glucose-lowering agents with cardiovascular and renal benefits started to increase after 2014, and at the same time, the use of older human insulins was almost entirely replaced with newer high-cost analogs. This study was a cross-sectional analysis of the 2003-2018 US National Health and Nutrition Examination Survey (NHANES).
The other study, of nearly 15,000 patients with type 2 diabetes in 37 countries, found that use of newer agents, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, has risen but remains suboptimal among individuals who could benefit from them the most.
Taken together, the data “underscore the challenges that we face when trying to manage diabetes not just as a disease of hyperglycemia but as a disease of hyperglycemia and increased micro- and macrovascular complications,” Rozalina G. McCoy, MD, associate professor of medicine at the Mayo Clinic, Rochester, Minnesota, told Medscape Medical News.
“If we think about diabetes simply as a condition where we have to lower blood glucose levels then it makes sense that we would use the cheapest option available,” she added.
“But it’s much more complicated than that, and it’s not just about lowering blood sugar. It’s about reducing cardiovascular events, reducing the progression of kidney disease, and preventing death. The only two medication classes that have been proven to do that in type 2 diabetes are GLP-1 agonists and SGLT2 inhibitors, and they are high-cost medications,” she said.
McCoy was not involved in either study but has conducted similar research.
Generics are coming online but aren’t yet widely available. But even once they are — and this will need to include them being placed on formularies [in some countries, such as the United States] — they still will be only part of the solution, McCoy believes.
“Just like with insulin, I think generics are part of the solution, but so is lowering the cost of brand-name drugs…We definitely don’t want patients to bear the burden of their diabetes financial management, but that shouldn’t” t come at the cost of not giving them evidence-based therapies that will improve their health. We really need to lower the cost of these drugs to make them affordable and accessible to patients and to the healthcare system,” she said.
Human Insulin Can Be SafelyUsed in Type 2 Diabetes
The NHANES study, recently published in the Journal of General Internal Medicine by Phuc Le, PhD, of Cleveland Clinic Community Care, Ohio, and colleagues, included 7394 representative US patients with type 2 diabetes.
Their use of low-cost noninsulin drugs (those with at least one generic available) increased from 37% in 2003-2004 to 54% in 2013-2014 (P < .001) and stabilized thereafter.