With rising concerns about the affordability of insulin, especially among Medicare Part D beneficiaries, healthcare providers are increasingly exploring cost-conscious yet clinically effective options for managing type 2 diabetes. Among these, neutral protamine Hagedorn (NPH)-containing human insulins have garnered renewed attention. Once a mainstay of insulin therapy, NPH insulin has often been sidelined in favor of long-acting insulin analogs due to concerns about glycemic variability and hypoglycemia risk. However, the cost differential between the two classes remains significant, prompting a re-evaluation of their real-world outcomes.

In a recent multicenter retrospective study conducted across three primary care clinics, researchers compared the rates of hypoglycemia, glycemic control, and changes in body mass index (BMI) among patients prescribed NPH-containing human insulin versus those on long-acting insulin analogs. The results were both clinically relevant and economically encouraging. Mild hypoglycemic events were reported in roughly one-third of patients in both groups (31.6% for analogs vs 33.3% for NPH), while severe hypoglycemia was rare and not significantly different between the two (3.5% for analogs vs 0% for NPH). Importantly, glycemic control, assessed via common indicators, remained comparable between both treatment arms, with no meaningful difference in BMI outcomes.

These findings suggest that, when appropriately monitored and titrated, NPH-containing human insulins may offer a safe and effective therapeutic pathway without the financial burden often associated with newer analog formulations. For providers navigating treatment decisions amid growing cost concerns, this evidence reinforces the clinical viability of revisiting older insulin options, particularly in patients for whom affordability may limit access to optimal care. In the Medicare population, where adherence can be closely tied to cost, such alternatives may hold the key to both sustainable care and meaningful outcomes.

Source: Hale, G., Marcellus, V., Benny, T., Moreau, C., Rosario, E., & Perez, A. (2023). Real-World analysis of Long-Acting and NPH-Containing insulins on glycemic Control. The Senior Care Pharmacist, 39(1), 42–49. https://doi.org/10.4140/tcp.n.2024. 42