Spike in utilization of insulins

[participant1]

I am noticing a consistent increase in the use of insulins. What could be contributing to this trend?

[chantell.reagan]

The increase in insulin utilization can most likely be attributed to the change in the ADA guidelines, first issued in 2006. For the first time, these guidelines specified treatment algorithm steps for Type 2 diabetes and insulin was identified as a possible "step 2." It is likely that manufacturers of insulin analogues have been promoting their products by increasing awareness of the new ADA recommendations.

Source: ADA. Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy. Diabetes Care. 2006;29:1963-1972.

[chantell.reagan]

The increase in use of insulins has also been noted by Medco and Walgreens in their 2008 drug trend reports.

Medco states that utilization growth for diabetes drugs in 2007 increased by 2.3%, which was partially driven by the growing use of Novolog and Lantus. Additionally, insulin unit costs sharply rose in 2007 at 14.5%, as there is no generic competition in this category. According to the Walgreens report, Lantus and Humalog appear in the top 5 utilized antidiabetic medications.

Sources:
Medco Drug Trend Website
Walgreens Health Initiatives Outlook Trend Report – 2008

[Nochmar]

I also think the fact that we are an aging and overweight society contributes to the incidence of Type 2 diabetes. We also live in the age of "take a pill or shot" to control the problem rather than saying no to the third Krispy Kreme of the morning.
I have noted an increase in Type 2 folks with out of control HbA1c's; These people are on metformin and maybe an SU. In Wisconsin, I think insulin is still a dirty word, among many patients, and many, many more people really need to be on it. If you walk through the clinic doors with an HbA1c of 10 or more, orals aren't likely to get you to goal without a lot of lifestyle change. Most people aren't up to those changes.