Tuesday, 27 September 2011

Is 'designer insulin' an expense too far?

A report on BBC news last week caught our eye. It was about some new research from Cardiff University that showed that the amount the NHS spends on insulin has risen massively in recent years. The researchers put this down to the use of more expensive, modern insulins that they dubbed ‘designer insulins’. These insulins are more commonly known as analogues, where their structure has been altered to provide a more even absorption or a shorter or longer length of action. The study reported that possible savings of £625m could have been made by the NHS if these insulins were not so widely used in Type 2 diabetes, and more traditional human insulin prescribed instead. This report raised several questions in our mind:

Firstly, how many people with any type of diabetes on analogue insulin would consider themselves to be the recipient of a designer product? They should be so lucky! Our experience is that most people think that if they have to be on insulin, then an insulin that causes them the least amount of hassle in their daily life might be preferable. It’s true that no insulin is perfect, but analogue insulins are a huge step forward in diabetes management. They are much easier to use in terms of timing, and also have got some track record in making both hypos and weight gain– two well known and hated side effects of insulin treatment – less likely.

Secondly – how does the idea of wholesale changing of insulin prescriptions fit with the health policy rhetoric of ‘no decision about me, without me’?  We would be the first to support this statement and whilst we admit that collaboration in consultations is not always all it might be, the thought of researchers telling prescribers how to cut back on their bills, leaving the person taking the medicine with no say in the matter and no chance to weigh up the pros and cons of a change, does not quite seem to be the way forward.

Thirdly, and maybe most importantly, the huge ongoing expense, in both physical and emotional terms, of the consequences of undiagnosed type 2 diabetes, the frequent delay in starting any kind of insulin (designer or otherwise), and the lack among many services of fundamental annual check ups (revealed by the most recently published national diabetes audit) and support for self management, would easily swallow up any savings that a purge on insulin prescriptions would make. These are the real health challenges in diabetes, not the type of insulin prescribed. In a way, it’s an easy win for the NHS to focus on prescribing costs, rather than investing in changing what happens within diabetes clinics. Designer insulin?  What we really need is designer diabetes services.

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