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Basu S, Shao H, Luo J, Lipska K, Suda KJ, Yudkin JS. Estimates of insulin needs and dispensation given wastage, alternative glycemic targets, and non-insulin therapies in US populations with type 2 diabetes mellitus: A microsimulation study. Journal of diabetes and its complications. 2021 Apr 1; 35(4):107839.
AIMS: Registries and health plans estimate insulin need for population health metrics. We sought to identify how such estimates affect population- and individual-level estimates of over- and under-treatment. METHODS: We developed a microsimulation comparing estimated insulin need to dispensation using the National Health and Nutrition Examination Survey (NHANES, 2005-2016, N = 2832) and Medical Expenditure Panel Survey (MEPS, 2005-2016, N = 29,615). RESULTS: From NHANES, ~21.6% of people with type 2 diabetes would require insulin to achieve a HbA1c target of 7% after maximum titration of two non-insulins (60.7?IU/person/day, or 84,629,833 vials of 1000?IU in the US). From MEPS, we observed 57.4?IU/person/day of insulin dispensed (81,585,842 vials). About 29% of people were dispensed at least two standard deviations less than their estimated need, and 22% at least two standard deviations more than estimated need. Population-level need estimates reduced 39.4% if liberalizing HbA1c targets to 8% for people = 75?years old. CONCLUSIONS: Estimated insulin needs of people with type 2 diabetes in the U.S. are consistent with their dispensed insulin at the population level, but are sensitive to HbA1c targets for older adults, and conceal under- and over-treated subpopulations.