There has been a shift from use of less expensive human basal insulins to costlier analog basal insulins for type 2 diabetes since the early 2000s. It is not known whether this trend has been uniform across patient groups or if these newer insulins are associated with improved outcomes in a nationwide sample. We performed statistical analyses using six consecutive cross-sectional National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2016 to determine patient characteristics and glycemic management associated with use of analog compared to human basal insulin. NHANES respondents were included if they had a diagnosis of diabetes, reported currently taking basal insulin, and did not meet criteria for type 1 diabetes. Demographic factors (age, sex, race), socioeconomic factors (educational attainment, health insurance status), and NHANES cycle were included in a logistic regression model predicting use of analog versus human basal insulin; subsequently all variables were included in models predicting HbA1c. Between NHANES cycles 2005-2006 and 2015-2016, 723 participants met inclusion criteria. Basal insulin use increased from 9.6% to 17.2% among respondents with type 2 diabetes. Among basal insulin users, analog basal insulin use rose from 58% in 2005-2006 to 88% in 2015-2016. Compared to non-Hispanic white respondents, African American respondents were less likely to report use of analog basal insulin (aOR 0.42, 95% CI 0.24-0.74), as were Hispanic respondents (aOR 0.54, 95% CI 0.30-0.96), after adjusting for age, sex, education, and health insurance status. Older age and having health insurance, but not type of basal insulin, correlated with achievement of HbA1c goals. The use of analog or human basal insulin is associated with race and ethnicity, but not with other demographic and socioeconomic measures. Increased use of analog basal insulins in the United States between 2005-2016 was not associated with improved glycemic control.
S. Cromer: Employee; Spouse/Partner; Johnson & Johnson. D.J. Wexler: Other Relationship; Self; Novo Nordisk A/S. P. Kazemian: None.
National Institutes of Health (T32DK007028)