Do we need insulin Analogue?

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Do we need insulin Analogue?

Lt. Gen. Mahmud Ahmad Akhtar
Former Surgeon General/DGMS/IS
Pakistan Armed Forces
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Cost of medicines for health care is a problem all over the world – much more acute in the resource poor countries. Pakistan which has more than half the population living below poverty line and the Government’s and its people with extremely scarce resources need cost-effective drugs. Insulin in particular is the case in point. Most patients suffering from diabetes mellitus, Type II, the most prevalent type, need insulin at later stages of treatment.

Insulin is available in two forms human insulin and analogue insulin: Analogue insulin is produced by genetically altering human insulin to improve pharmacological properties such as speed of bioavailability. The companies manufacturing the insulin analogues have altered human insulin to a degree far in excess of “National Institute of Health and Care Excellence (NICE)” guide-lines.1 The cost of analogue insulin is ten times of human insulin.

Most systematic reviews of analogue insulin find them to be of marginal advantage compared with human insulin. The long-acting analogues, in particular, which are those mainly used in people with type 2 diabetes, offer no significant benefits, unless patients have been having symptomatic hypoglycaemia, particularly at night, a rare situation. Yet despite the limited evidence of the added value of analogue versus human insulin, this type of insulin has gained significant market share. We are living in a world where resources are being wasted on products that show no worthwhile benefits2 Brean and Dryudkin have termed the double scandal of insulin, the one that three multi-national companies have monopolized the pricing and sale of insulin analogues and second the prescribing doctors.3

With the increasing economic and health burdens of diabetes this should be an issue of concern to us all. The German institute for “Quality and Efficiency” in healthcare decided in 2006 that the use of analogues in type 2 diabetes would not be re-imbursed.

In Pakistan there is more reason to it that insulin analogues should be used very rarely; if at all. It is unfortunate to see the use of insulin analogues on a much higher scale in Pakistan due to the uncontrolled aggressive promotional activities of the concerned companies and the prevailing corrupt practices. It is high time that the Government and the professional bodies issue guideline on the rational use of insulin analogue and prevent analogue abuse.

References

1. National collaborating center for chronic conditions type 2 diabetes. National clinical guideline for management in primary and secondary care (update) [Internet]. London Royal college of physicians: 2008 [cited 2013 June 21] Available from http//www.nice.org uk/nicemedia/rdt/cg. 66 full guideline 0509. pdf.
2. Gill GY, Yudkin JS, Keen H, et al. The insulin dilemma in resource limited countries. A way forward? Diabetologa 2011; 54;54:19-24. http//dx.doi.org/10;1007/soo/25-010-1897-3.
3. Beran D, Yudkin JS. The double scandal of insulin. JR Coll Physicians Edin 2013; 43: 194-6.