Managing diabetes-related costs and quality of life issues: Value of insulin analogs and pens for inpatient use

Diabetes mellitus is a serious disease that is growing at an epidemic rate, yet it can be managed and controlled with appropriate individualized therapy. In the hospital, costs can be reduced and health-related quality of life (HRQOL) improved by optimal glycemic and blood pressure control, minimal or no hypoglycemia, minimal glucose fluctuations, fewer or no complications, and a shorter length of stay. Insulin analogs and pens are tools that have been used successfully to manage hyperglycemia in the inpatient and outpatient settings. Limited evidence suggests that these advances in insulin therapy may increase HRQOL and improve cost-effectiveness in hospitalized patients compared with regular and NPH insulin and vial/syringe administration of insulin, although additional data are needed to confirm these findings. Most insulin algorithms used in hospitals rely on analogs for basal and prandial glucose control; however, analogs have not been extensively evaluated in clinical trials in this patient population. More studies are needed to evaluate the impact of insulin pen and analog use on HRQOL and costs in hospitalized patients.