The Pharmaceutical Journal
Vol 279 No 7475 p460
27 October 2007

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Patients should be more involved in insulin choice

People with diabetes must be given more information about the risks and benefits of using different insulins and more choice about the insulins they use, according to the Insulin Dependent Diabetes Trust (PDF 920K).

“As a largely self-managed condition, being involved in treatment decisions is extremely important for people with diabetes,” the IDDT says. “Different insulins have different speeds and durations of action and it is important that patients have the choice of insulin which is the most suitable for their lifestyle, while providing the best possible control of blood glucose levels.”

In a report published to coincide with the 30th anniversary of the first clinical trial of a synthetic insulin, the IDDT describes the lack of information about risks and benefits given to patients switched from animal insulin to genetically engineered (human) insulin.

Reports of symptoms such as loss of warning of hypoglycaemia and personality changes are ignored, and patients are neither allowed to revert to animal insulin treatment nor allowed to try it for the first time.

A similar failure to provide information about risks and benefits is occurring as patients are switched to analogues, and choice of treatment is becoming increasingly limited as animal and human insulins are discontinued, the report warns.

The IDDT says that there should be no further discontinuations of insulins until the safety of all synthetic insulins has been established for everyone requiring insulin treatment.

The IDDT also highlights the fact that many primary care trusts are failing to meet targets for standards of care and treatment for people with diabetes, while funding treatment with insulin analogues.

“Insulin analogues are significantly more expensive for the NHS than either ‘human’ or animal insulins and the evidence of benefit for the majority of patients is negligible,” the report says.

The report calls for research into the effect of different insulins on outcomes such as mortality, complication rates and quality of life, and into the long-term safety of insulin analogues.