Patients were given two-thirds of TDD at breakfast and one-third of TDD at dinner then titrated to target predinner glucose and fasting glucose, respectively. Clinical pharmacists determined the total daily dose (TDD), discontinued the basal and prandial insulins and other secretagogues, and converted to premixed insulin by 20% less than the calculated TDD. Patients who were on both basal and prandial insulin receiving at least 50 units/day, without any history of hypoglycemia and adherent to insulin, were eligible for the conversion. In February 2015, CareMore started a protocol-driven intervention to switch from higher-cost analogues to lower-cost human insulin in patients with T2D led by clinical pharmacists at various Comprehensive Care Clinics. The organization found that its Medicare Advantage patients were using analogues that had a high daily injection burden (ie, basal-prandial insulin strategies) and were reaching the Medicare Part D coverage gap. 4ĬareMore Health, a care delivery system, examined its insulin spending in 2014. In addition, Fullerton et al’s systematic review comparing short-acting analogue insulin versus regular human insulin in adults with type 2 diabetes (T2D) demonstrated no clear benefit of short-acting analogue insulin over regular human insulin. 3 The only differentiation made between the 2 insulins by the ADA is the high cost of analogues and the low cost of human insulin. The guideline states that once-daily basal insulin injection therapy is associated with minimal adverse effects while multiple daily injections may be too complex for older patients. The American Diabetes Association Standards of Medical Care in Diabetes-2019 currently does not provide guidance for analogues versus human insulin. Studies comparing the clinical efficacy of analogue insulin to human insulin are scarce. ![]() High prices and lack of availability are thought to be key contributors to poor insulin access. 2 However, 1 in 2 people needing insulin lack access globally. 1 Insulin is considered the most effective medication to achieve glucose control and avoid further complications in patients with diabetes.
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