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Estimation of Global Insulin Utilization for Type 2 Diabetes Mellitus, 2018 to 2030: A Microsimulation Model
44 Pages Posted: 5 Oct 2018
More...Abstract
Background: As type 2 diabetes mellitus (T2DM) becomes more common worldwide, the amount of insulin needed to treat T2DM effectively globally iscrucial but unknown. It also remains unclear how alternative treatment algorithms would affect global insulin use and T2DM complication rates.
Methods: We developed a microsimulation of T2DM burden from 2018 to 2030 across 221 countries and territories using data from the International Diabetes Federation for prevalence projections and from fourteen cohort studies representing >60% of the global T2DM population for hemoglobin A1c, treatment, and weight data. We estimated the number of people with T2DM expected to use insulin, international units (IU) used, and disability adjusted life years (DALYs) gained by improved insulin access under alternative treatment algorithms.
Results: Overall insulin use would increase from 516.1 million 1000IU vials (95% CI: 409.0, 658.6 million) to 633.7 million per year (95% CI: 500.5, 806.7 million) between 2018 and 2030. Without improved insulin access, 7.4% (95% CI: 5.8%, 9.4%) of the 510.8 million people with T2DM in 2030 would use insulin, increasing to 15.5% (95% CI: 12.0% to 20.3%) if insulin were widely accessible and prescribed to achieve a target hemoglobin A1c of 7% (53 mmol/mol). If achieving A1c of 7%, insulin would avert 331,000 DALYs per year by 2030 (95% CI: 256,600, 437,100), increasing by 14.9% with access to newer oral glycemic agents, and 44.2% if achieving A1c of 8% (64 mmol/mol) for people >75 years old, due to lower rates of hypoglycemia.
Discussion: The amount of insulin required to treat T2DM is expected to increase by over 20% over the period 2018-2030. Insulin treatments may avert more DALYs if HbA1c targets are higher for older adults.
Funding: Helmsley Trust
Declaration of Interest: None.
Suggested Citation: Suggested Citation