How small changes led to big profits for insulin manufacturers

  title={How small changes led to big profits for insulin manufacturers},
  author={Deborah Cohen and Philip Carter},
  journal={BMJ : British Medical Journal},
In the first of a series of investigations by the BMJ and Channel 4 News, Deborah Cohen and Philip Carter discover why more expensive analogue insulins are increasingly prescribed instead of cheaper human insulin despite lack of evidence of benefit for patients with type 2 diabetes 

Bad medicine: the way we manage diabetes

  • D. Spence
  • Medicine
    BMJ : British Medical Journal
  • 2013
The drug industry’s business plan for diabetes follows a familiar pattern, with new drugs and the increasing use of analogue insulin in type 2 diabetes worth tens of billions of pounds worldwide.

Evaluation of the incremental cost to the National Health Service of prescribing analogue insulin

Given the high marginal cost of analogue insulin, adherence to prescribing guidelines recommending the preferential use of human insulin would have resulted in considerable financial savings over the period.

Choice of Long-Acting Insulin Therapy for Type 2 Diabetes

Insulin replacement therapy becomes necessary as the efficacy of oral glucose-lowering agents wanes during prolonged treatment, and avoidance of iatrogenic hypoglycaemia assumes particular importance in older people.

Old and new basal insulin formulations: understanding pharmacodynamics is still relevant in clinical practice

Optimizing basal insulin treatment, especially in type 2 diabetes patients who are less prone to hypoglycaemia, would be suitable making significant resources available for other relevant aspects of diabetes care.

Insulin Glargine in a Brazilian State: Should the Government Disinvest? An Assessment Based on a Systematic Review

This systematic review showed no therapeutic benefit of insulin glargine over other insulin formulations studied when analysing together glycaemic control and the frequency and severity of hypoglycaemia, and recommended to the State Authority to delist insulinglargine or renegotiate a price reduction with the manufacturer.

THERAPY OF ENDOCRINE DISEASE: Insulin initiation in patients with type 2 diabetes mellitus: treatment guidelines, clinical evidence and patterns of use of basal vs premixed insulin analogues

The evidence presented suggests that a major component of the HbA1c not being attained in every day clinical practice may be a result of factors that are not adequately addressed in forced titration trials of highly motivated patients, including failure to comply with complex treatment and monitoring regimens.

A study of the descriptive epidemiology and clinical effectiveness of treatment for type 2 diabetes using routine general practice data

Estimated insulin dose was associated with an increased risk of all-cause mortality in people with type 2 diabetes receiving insulin monotherapy and in those treated with insulin with or without metformin and the use of met formin in combination with insulin wasassociated with a reduction in risk compared with insulin alone.

Priority-Setting Processes for Expensive Treatments for Chronic Diseases

Although the focus of this chapter is on high-cost treatment, the need for a legitimate and evidence-driven priority-setting process applies to all health conditions and diseases, and preventive measures cannot be ignored.



Estimation of primary care treatment costs and treatment efficacy for people with Type 1 and Type 2 diabetes in the United Kingdom from 1997 to 2007 *

Diabet. Med. 27, 938–948 (2010)

Meta‐analysis of individual patient data to assess the risk of hypoglycaemia in people with type 2 diabetes using NPH insulin or insulin glargine

Aim: To estimate absolute and relative incidence rates of hypoglycaemia when using once‐daily evening or morning regimens of insulin glargine (glargine) versus once‐daily evening NPH insulin (NPH)

Cost-effectiveness of insulin analogues for diabetes mellitus

Routine use of insulin analogues, especially long-acting analogues in type 2 diabetes, is unlikely to represent an efficient use of finite health care resources and depends on the type of insulin analogue and whether the patient receiving the treatment has type 1 or type 1 diabetes.

Nice insulins, pity about the evidence

In February 2006 the German Institute for Quality and Efficiency in Healthcare (IQWiG), an independent body with a mandate to assess the evidence for medical interventions, released its final report

The market in diabetes

How the market in diabetes has changed over the past 10 years is described and how it might change over the next 5 years is considered.

Similar progression of diabetic retinopathy with insulin glargine and neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes: a long-term, randomised, open-label study

This study shows no evidence of a greater risk of the development or progression of diabetic retinopathy with insulin glargine vs NPH insulin treatment in patients with type 2 diabetes mellitus.

NovoSol Basal: pharmacokinetics of a novel soluble long acting insulin analogue.

NovoSol Basal seems to be an appreciable advance over Ultratard HM as a soluble insulin preparation for obtaining reproducible 24 hour insulin concentrations in the blood.

Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation.

The clinical effectiveness and cost-effectiveness of using CSII to treat diabetes and to update the previous assessment report by reviewing evidence that has emerged since the last appraisal, and to take account of developments in alternative therapies, in particular the long-acting analogue insulins.

Prescribing for diabetes in England-an update

  • Diabetes Health Intelligence
  • 2002

Diabetes and Oncology IR thematic seminar