Revisiting NPH Insulin for Type 2 Diabetes: Is a Step Back the Path Forward?

In spring 2017, the American Diabetes Association tasked a working group with examining soaring insulin list prices, which had nearly tripled between 2002 and 2013. Because pharmaceutical spending represents a prime contributor to the escalating costs of diabetes care in the United States, these increases in insulin pricing warranted analysis. High insulin prices have additional adverse consequences for individuals with diabetes. These adverse consequences include nonadherence and nonpersistence (ie, premature discontinuation of prescribed therapies) and represent an important problem in need of solutions. The basal insulin analogs glargine and detemir have largely supplanted once-popular human insulins (eg, neutral protamine Hagedorn [NPH]), for type 2 diabetes at more than 10 times the price. To justify their high cost, the relative clinical benefits of basal insulin analogs should be clear and compelling.