Cost and efficacy have created renewed interest in NPH and regular insulin, two “old school” diabetes treatments seemingly pushed to the background in the past 10 to 15 years.
Four experts will examine the various insulin treatment options during a Monday afternoon symposium titled Insulin Therapy—To the Future and Back, which will begin at 4:30 p.m. in room W415B (Valencia Ballroom).
Dace Trence, MD, Director of the Diabetes Care Center and the University of Washington Endocrine Fellowship Program, and Professor of Medicine at UW Medicine, will review some of the older insulins that had been all but abandoned but are now finding favor again. She will also discuss when and how to use NPH and regular insulin in patients with type 1 and type 2 diabetes.
“There was a reason why newer insulins were developed—to try to get around some of the challenges, specifically hypoglycemia, with these older insulins,” Dr. Trence said. “But as time has gone on and the cost of insulin, in general, has escalated, people are returning to these insulins to really be able to afford insulin medications.”
In addition to cost-effectiveness, NPH and regular insulin offer other benefits, particularly for patients who have a considerable amount of insulin resistance, Dr. Trence added.
Since these older insulins don’t have the same flexibility and predictability as newer insulins, clinicians must make sure patients understand the importance of regular eating to avoid hypoglycemic events. Some clinicians haven’t worked with older insulins this century, Dr. Trence said, as new insulins are seemingly introduced on a yearly basis.
“There’s this impetus to use the new way and be more familiar with the newer insulins, of course, so you kind of forget that the older insulins work a bit differently,” Dr. Trence said. “Certainly, people are familiar with the literature, and we see all these graphics of all the available insulins and their peak effect and their duration of action. But to actually have a feel for what that means on a person-to-person basis is quite different.”
Also during the symposium, Wendy S. Lane, MD, of Mountain Diabetes and Endocrine Center in Asheville, North Carolina, will review the pharmacological differences between the newer concentrated insulin formulations and the parent U100 formulations.
Dr. Lane said that the obesity epidemic created a need for higher insulin doses and led to the development of concentrated insulin products such as U200 degludec, U200 lispro, U300 glargine, and U500 regular insulin.
“The concentrated insulin products are not interchangeable, and there are specific patients who will benefit from each product depending on patient characteristics and insulin requirement,” she said.
Dr. Lane will review recent clinical studies on the efficacy of several concentrated insulin products. She will also discuss the need for concentrated, rapid-acting insulin for use in insulin pumps. She will review several clinical case studies that demonstrate the safety and efficacy of U200 lispro and U500 regular insulin in pumps, which are currently off-label uses.
Also during the symposium, Carol H. Wysham, MD, from the University of Washington/Multicare Rockwood Clinic, will discuss which patients should receive the new, ultra-long-acting basal insulin products. And Tim Heise, MD, a Lead Scientist at Profil in Neuss, Germany, will analyze the realistic expectations of the new and developing rapid-acting insulins.