Publication: A retrospective cohort study on the effect of intensification from human to analogue insulin on glycaemic control and insulin cost in patients with type 2 diabetes mellitus in Hospital Universiti Sains Malaysia
Date
2022
Authors
Hussin, Siti Aisyah
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Abstract
Background: Type 2 diabetes mellitus (T2DM) is primarily due to insulin resistance and deficiency. It is manifested by a chronic hyperglycaemic state and other metabolic derangements. Uncontrolled T2DM will lead to multiorgan complications, hence the importance of achieving good glycaemic control. Analogue insulins are associated with better adherence with lower hypoglycaemic episodes; however more expensive. This study aims to evaluate the efficacy of intensification from human to analogue insulin and the added cost. Methods: This retrospective study was conducted at the medical outpatient clinic at Hospital Universiti Sains Malaysia (HUSM). Patients with T2DM who were on analogue insulin were identified from the outpatient pharmacy database from 2010 to 2020. From this database, patients who underwent intensification for at least three months from human to analogue insulin were included in the study. The patient's medical records and investigation results (Hba1c and FBS) were retrieved from Prescription On – Line System (POLS), online discharge summary and Laboratory Information System (LIS). The total cost pre and post intensification of insulin were calculated using insulin price obtained from the pharmacy using Drug Pharmacy Inventory Management System (SPIFU). Hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and total insulin cost pre and post intensification of patients who fulfilled the criteria were analysed using paired t-test. Result: A total of 163 patients with T2DM who had intensification from human to analogue insulin at HUSM were included in this study, which consisted of 80 (49.1%) males and 83 (50.9%) females. The age of the patients ranged between 27 to 75 years old, with a mean age of 57.87±10.20 years old. 51 (31.3%) of them had basal insulin, 72 (44.2%) had premixed insulin, 16 (9.8%) had basal bolus insulin, and 24 (14.7%) had bolus insulin. Both HbA1c and FBS levels were significantly lower in analogue insulin compared to human insulin (p<0.05), respectively, however not clinically significant as the mean reduction of HbA1c is less than 0.5%. Total costs of analogue insulin for three months were statistically higher compared to human insulin (397.55±242.10 vs. 104.70±71.29; p<0.001), with a mean difference of Ringgit Malaysia 292.85 (95% CI:265.79, 319.91). Conclusion: In conclusion, there were no clinically significant improvements in patients' HbA1c and FBS after intensification from human to analogue insulin, despite the extra cost spent, not considering other factors such as hypoglycaemic episodes and reduction in hospitalisation and diabetes-related mortality rate. Hence, it is vital that physicians choose the right group of patients to receive insulin analogue to maximise its benefit but at the most optimal cost.
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Keywords
T2DM , analogue insulin