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Record rise of insulin use in UK tied to increase in type 2 diabetes
The prevalence of insulin use more than tripled in the United Kingdom from 1991 to 2010, with type 2 diabetes diagnoses seeming to be a major cause, according to recent study data published in Diabetes, Obesity and Metabolism.
“Also during this period there was more than a sevenfold increase in the number of those with a diagnosis of type 2 diabetes and treated with insulin. Most of this is unrelated to clinical need. Insulin is very expensive and some of us believe that it involves too many serious side effects in people with type 2 diabetes,” Craig J. Currie, PhD, professor of applied pharmacoepidemiology at Cardiff University’s School of Medicine, said in a press release.
Currie and colleagues conducted a retrospective analysis of the Clinical Practice Research Datalink to determine insulin use rates from 1991 to 2010. Insulin use was defined as a patient who was issued two prescriptions of insulin per year.
Their research showed that the crude prevalence rate of insulin use increased from 2.43 per 1,000 population (95% CI, 2.38-2.49) in 1991 to 6.71 per 1,000 (95% CI, 6.64-6.77) in 2010, with the largest change seen in the prevalence of insulin users diagnosed with type 2 diabetes (0.67 to 4.34 per 1,000). Additionally, in 1991, more insulin-using patients were diagnosed with type 1 diabetes than type 2 diabetes (98,000 vs. 37,000), but by 2010, those numbers had reversed (134,900 with type 1 vs. 277,400 with type 2).
“The rising prevalence of insulin use probably reflects both an increase in incidence and longer survival of those who already have type 2 diabetes. The financial cost of insulin to the [National Health Service] in the UK is estimated to have increased from 156 [million pounds] in 2000 to 359 [million pounds] in 2009,” Currie said in the release. “The increase in the number of people with type 2 diabetes using insulin is a wake-up call for all — not only in terms of lifestyle choices and how we treat people with type 2 diabetes.”
The mean age of insulin initiation increased with each 5-year period; insulin was initiated at 52.5 years in 1991-1995, but 58.1 years in 2005-2010. The same 5-year periods showed little change in baseline mean HbA1c: 10% in 1991-1995; 9.7% in 1996-2000; 9.7% in 2001-2005; and 9.8% in 2006-2010.
“Somewhat counter‐intuitively, this [increase in insulin delivery] does not appear to have been driven by earlier initiation of insulin in response to national guidelines, since the HbA1c level at which insulin is introduced has not fallen over 20 years and remains alarmingly high at 9.8%. Nor has the achieved HbA1c in established insulin users fallen below its average of 8.5%. These observations should prompt a closer re‐examination of the extent to which national policies have been translated into routine care,” the researchers wrote.
In addition, data showed that the percentage of patients with type 2 diabetes who were taking insulin alone, as opposed to combined with other glucose-lowering agents, decreased from 97% in the first decade to 37% in the second. The researchers attributed this to prominent studies and agency recommendations during the course of the study period, as well as marketing efforts.
Disclosure: Currie reports receiving research grants from various organizations. Other researchers are employed by Pharmaintelligence, a research consultancy receiving funding from pharmaceutical companies, and Alliance Boots. Please see study for full list of disclosures.