Maybe Old is Gold? Newer Insulins Might Not Be Better – Just More Expensive

September 21, 2018

Fredrick Banting, the Canadian scientist who discovered insulin in 1921 and sold the patent for just $1 to the University of Toronto and made it available to pharmaceutical companies royalty-free, would be disappointed to know that the high cost of insulin is now a major barrier to treatment. The average price of insulin has nearly tripled, from $4.34/ml in 2002 to $12.92/ml in 2013. Insulin’s high cost affects everyone: (1) uninsured patients, (2) insured patients with high co-payments and deductibles, (3) Medicare beneficiaries with coverage gaps and fixed income, and (4) everyone else paying higher premiums to offset the insurers’ expenditures. Are the newer insulins really worth the extra cost?  A new study by investigators at Kaiser Permanente Northern California suggests that most patients can safely use NPH insulin instead of more expensive insulin analogs.

Download the podcast patient case:  NPH vs Insulin Analogs

Guest Authors:  Jaini Patel, PharmD, BCACP and Regina Arellano, PharmD, BCPS

Music by Good Talk

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Using Sotagliflozin In Tandem with Insulin: Weighing the Benefits in Type 1 Diabetes

April 13, 2018

Patients with type 1 diabetes often have sub-optimal glycemic control.  The gold standard of treatment is basal-bolus insulin or continuous subcutaneous insulin infusion via an insulin pump.  However, only a third of patients with type 1 diabetes achieve the American Diabetes Association A1C goal <7%.  There has been particular interest in using SGLT-2 inhibitors in patients with type 1 diabetes due to their ability to decrease body weight and blood pressure as well as improve glycemic control and perhaps cardiovascular outcomes. InTandem3 was a phase III, multicenter, randomized, double-blind, placebo-controlled trial evaluating the safety and efficacy of sotagliflozin, a novel dual SGLT 1 and 2 inhibitor, in patients with Type 1 diabetes.

Guest Author:  Diana Isaacs, Pharm.D., BCPS, BD-ADM, CDE

Music by Good Talk

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Is there a Role for Fixed-Ratio Injectable Combinations in Type 2 Diabetes?

January 13, 2017

Pharmacotherapy for diabetes management has expanded in recent years with several new drug classes. Current guidelines recommend several options for patients who have not reached their goal A1c on metformin monotherapy including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or basal insulin. However, if basal insulin is chosen as the first add-on treatment with metformin, the post-prandial blood glucose (PPG) often will remain elevated.  A combination product that includes both a basal insulin plus a GLP-1 RA has the potential to addresses both fasting blood glucose and PPG … and perhaps has some other advantages over using either product alone.

Theme Music by Good Talk

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Reconsidering Strategies for Insulin Intensification

March 11, 2016

Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25, 50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for patients with diabetes requiring insulin continues to expand. Current guidelines for glycemic management of patients with type 2 diabetes provide specific recommendations for the initiation of insulin therapy, but not insulin intensification. The recently published LanScape study provides a foundation for making evidence-based clinical decisions.

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Insulin Delivery in Type 2 Diabetes: To Pump or Not to Pump?

July 10, 2015

The American Diabetes Association and European Association for the Study of Diabetes (ADA/EASD) guidelines acknowledge that “CSII is a less commonly used and more costly alternative” to basal-bolus therapy in patients with T2DM.  The Opt2mise was a robust study intended to clarify the role of CSII in patients with T2DM.

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