A changed pattern of insulin use following the introduction of basal analog insulin treatment in primary care.
OBJECTIVE
We analyzed the impact of the removal of administrative restrictions on basal analog insulin prescribing by primary care physicians in the year 2008 in a large HMO.


METHODS
This cross-sectional database study of patients with diabetes study was conducted in Maccabi Healthcare Services, the second largest HMO in Israel, insuring 1.9 million members countrywide. The research population included men over 40 and women over the age of 45 from MHS diabetes registry during the time period 1.1.2002-31.12.2009.


RESULTS
After removal of basal analog insulin prescription restrictions, more primary care physicians initiated treatment with basal analog insulin than with other types of insulin and did so with fewer referrals for specialty diabetes consultation. No growth in the relative number of patients commencing insulin use was observed, nor did we find an earlier initiation of insulin.


CONCLUSIONS
In the first year following the relaxation of prescribing restrictions on the use of basal analog insulin we observed an increase in its use amongst patients previously treated with other types of insulin. The administrative changes did not result in an overall increase in the use of insulin in the study population.
Maccabi Healthcare Services, Tel Aviv, Israel. Heymann_t@mac.org.il
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Heymann
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Kritz
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Hemo
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Kertes
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Becker
D000328:Adult; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000639:trends; D017723:Drug Utilization Review; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D007557:Israel; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors
D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human