Abstract

Only 26% of people with diabetes in the US use insulin, even though 44% have A1c levels over 7%. Cost may be a barrier to insulin use, and, thus biosimilar insulin (BI) offers potential savings. A regulatory pathway for biosimilar drugs was created in 2010, and several preparations are in development. This study’s purpose was to assess the openness of diabetes patients and certified diabetes educators (CDEs) to BI. In mid-2011 we surveyed a panel of subscribers to a diabetes patient newsletter (diaTribe) and a panel of US CDEs about their willingness to use or recommend BI, respectively. A total of 1,637 insulin users (65% type 1, median age 49 yrs, 62% female, median household income $25,000-$49,999, 67% bachelor’s degree or higher, 81% private health insurance) and 415 educators (52% outpatient hospital setting, 28% private office, mean 21 patients per week) responded to the survey. Both surveys specified that BI would be priced favorably relative to current insulins; patients were to assume healthcare provider approval. Most patients said they would “definitely” (30%) or “likely” (37%) use BI, while only 17% said “unlikely” or “definitely not.” Answers of “definitely” were more common among patients currently using NPH (46%, n=26) or premixed insulin (41%, n=36) than rapid-acting analogs (28%, n=341); “definitely” answers were also more common among those with type 2 diabetes (38%, n=213) than adults (29%, n=256) or children (13%, n=26) with type 1 diabetes. Most CDEs said they would “definitely” (41%) or “likely” (42%) recommend BI, with only 5% saying “unlikely” or “definitely not.” In open-ended follow-up questions, vast majorities of both groups stressed that BI must be identical to current insulin in safety, efficacy, action profile, and/or quality. Thus the study’s results are contingent on these factors. We conclude there is significant interest in the future use of BI among patients and CDEs that could result in major transformation in insulin usage in the US.