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Cost-Related Insulin Underuse Evaluated

JAMA Intern Med; ePub 2018 Dec 3; Herkert, et al

1 in 4 patients at an urban diabetes center reported cost-related insulin underuse and this was associated with poor glycemic control, according to a recent study. Researchers administered a survey to patients with type 1 or type 2 diabetes for whom insulin was prescribed within the past 6 months and who had an outpatient visit at the Yale Diabetes Center (YDC) between June and August of 2017. They then examined the association between cost-related underuse and poor glycemic control (HbA1c ≥9%) adjusting for sex, body mass index (BMI), diabetes duration, and income. They found:

  • Of 354 eligible patients, 199 (56.2%) completed the survey.
  • Of these patients, 51 (25.5%) reported cost-related insulin underuse.
  • Patients with cost-related underuse were more likely to report lower incomes; 31 [60.8%] of these patients discussed the cost of insulin with their clinician and 15 [29.4%] changed insulin type owing to cost.
  • Patients who reported cost-related underuse (vs those who did not) were more likely to have poor glycemic control in the multivariable analysis (22 [43.1%] vs 41 [28.1%]).

Herkert D, Vijayakumar P, Luo J, et al. Cost-related insulin underuse among patients with diabetes. [Published online ahead of print December 3, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.5008.