Is Tight Glycemic Control in Type 2 Diabetes a Good Investment?

Type 2 diabetes mellitus (T2DM) affects 284 million people globally, and the American Diabetes Association indicates that almost 2 million Americans are diagnosed with T2DM annually. The result: an enormous healthcare burden, most of which is attributed to treatment of micro- and macrovascular long-term complications. Increasingly, experts and researchers are advocating for tighter glycemic control. In a recent issue of Clinical Medicine Insights: Endocrinology and Diabetes, an international team reports that aggressive treatment with insulin or an insulin analogue is cost-effective.

Noting that early introduction of insulin (as opposed to using multiple oral agents) may prevent complications, these researchers reviewed English peer-reviewed articles published after 2000 that looked at economic consequences of T2DM treatment intensification. These found several interesting facts:

• Inpatient care for treatment of complications drives costs associated with T2DM and accounts for between 40% and 60% of total T2DM-associated cost.
• Drug therapy for glycemic control representing 18% of the total cost.
• Insulin therapy improves glycemic control and reduces complications better than all other glucose lowering agents despite possible hypoglycemia and weight gain.
• There is a tendency for clinicians to prescribe insulin only after patients experience prolonged periods of poor control, and many of these patients continue to have poor control after starting insulin-type therapies
• Tight glycemic control’s benefits are optimal in patients who self-monitoring regularly and well.
• Although more costly than human insulin, insulin analogs are probably more cost-effective due to improved glycemic control and reduced propensity for hypoglycemia and weight gain.

The researchers write, “Earlier introduction of insulin therapy may be more cost-effective than prescription of multiple oral therapies with or without incretin therapy. Early treatment intensification with insulin analogs in patients with poor glycemic control appears to be cost-effective and improves clinical outcomes.” We look to the future for new insulin formulations that will lead to better control with fewer adverse events, and make it easier for T2DM patients to manage their disease.