(96) Trends in Insulin Types and Devices Used by Adults with Type 2 Diabetes in the United States, 2016 to 2020

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1141

Presenting Author(s)

James Heyward, MPH
– Bloomberg School of Public Health, Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

Co-Author(s)

Sudipa Sarkar
– Assistant Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
G. Caleb Alexander, MD
– Professor of Epidemiology and Medicine, JHSPH Center for Drug Safety & Effectiveness, Baltimore, Maryland, United States
Rita Kalyani
– Associate Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States

Background: Despite rising costs and public scrutiny devoted to insulin, less is known regarding recent trends in its ambulatory use in the United States.

Objectives: To characterize trends in ambulatory insulin use, overall and based on insulin characteristics, among adults with type 2 diabetes in the United States from January 1, 2016, through December 31, 2020.

Methods: We conducted a descriptive analysis of serial cross-sectional data using the IQVIA National Disease and Therapeutic Index (NDTI), a nationally representative audit of ambulatory physician practices in the United States. We focused on visits for type 2 diabetes among patients over the age of 35 in which one or more drugs were prescribed (“treatment visits”). We assessed prescribing of insulin for type 2 diabetes, both overall and aggregated by insulin molecule, delivery devices, therapeutic class, insulin type, and date of approval.

Results: The total number of insulin treatment visits declined from a peak of 6.0 million visits in 2016 to a nadir of 4.9 million visits in 2020 (approximately 18% decline). Among all insulin treatment visits in 2020, 1 989 154 (43.9%) were among those aged 60 to 74 years; 2 372 629 (52.4%) among men; 2 646 247 (58.4%) among White patients; 811 639 (17.9%) among Black patients; and 701 912 (15.5%) among Hispanic patients. Insulin glargine was used in almost half of treatment visits from 2016 to 2020 (eg, 2020: 2.6 of 4.9 million visits; 95% CI, 2.1-3.1 million). Among insulin classes, long-acting insulin accounted for approximately two-thirds of treatment visits during this period (eg, 2020: 3.7 million visits; 95% CI, 3.0-4.4 million). Treatment visits for insulin pens increased from 36.1% in 2016 (2.2 of 6.0 million visits; 95% CI, 1.7-2.7 million) to 58.7% in 2020 (2.9 million visits; 95% CI, 2.3-3.5 million), while use of insulin vials/syringes declined in parallel. Analog insulin use predominated and accounted for more than 80% of total treatment visits across all years (eg, 2020: 4.3 million visits; 95% CI, 3.4-5.1 million). Newer insulins were increasingly used, from 18.1% of total treatment visits in 2016 (1.1 million visits; 95% CI, 0.8-1.4 million) to 40.9% in 2020 (2.0 million visits; 95% CI, 1.5-2.5 million). The use of biosimilar insulin, which was first approved in 2015, increased from 2.6% in 2017 (0.1 of 5.3 million visits; 95% CI, 0.04-0.2 million) to 8.2% in 2020 (0.4 million visits; 95% CI, 0.2-0.6 million) of total insulin treatment visits.

Conclusions: In this study, ambulatory insulin use in the United States during the past 5 years remained dominated by the use of insulin analogs and insulin pen delivery devices, with increasing uptake of newer products as they have been brought to market.