Basu S, et al. - Researchers performed a comparison of alternative projections for and consequences of insulin use worldwide under varying treatment algorithms and degrees of insulin access. Outcomes indicate that from 2018 to 2030, more than 20% increase in insulin required to treat type 2 diabetes is expected. They suggest higher HbA_1c targets for older adults to avert more disability-adjusted life-years (DALYs).

Methods

• From 2018 to 2030, a microsimulation of type 2 diabetes burden across 221 countries was developed using data from the International Diabetes Federation for prevalence projections and from 14 cohort studies representing more than 60% of the global type 2 diabetes population for HbA_1c, treatment, and bodyweight data.
• Estimation was done of the number of people with type 2 diabetes expected to use insulin, international units (IU) required, and DALYs averted per year under alternative treatment algorithms targeting HbA_1c from 6·5% to 8%, lower microvascular risk, or higher HbA_1c for those aged 75 years and older.

Results

• Outcomes suggest an estimated increase in the number of people with type 2 diabetes worldwide from 405·6 million (95% CI 315·3 million–533·7 million) in 2018 to 510·8 million (395·9 million–674·3 million) in 2030.
• On this basis, an increase in insulin use is estimated from 516·1 million 1000 IU vials (95% CI 409·0 million–658·6 million) per year in 2018 to 633·7 million (500·5 million–806·7 million) per year in 2030.
• In case no improvement in insulin access occur, 7·4% (95% CI 5·8–9·4) of people with type 2 diabetes in 2030 would use insulin; this may increase to 15·5% (12·0–20·3) if insulin were widely accessible and prescribed to achieve an HbA_1c of 7% (53 mmol/mol) or lower.
• In case of achieving HbA_1c of 7% or lower universally, insulin would avert 331,101 DALYs per year by 2030 (95% CI 256 601–437 053).
• With access to newer oral antihyperglycaemic drugs, increase in DALYs averted by 14·9% is expected.
• An increase in DALYs averted by 44·2% is expected if an HbA_1c of 8% (64 mmol/mol) were used as a target among people aged 75 years and older because of reduced hypoglycaemia.