New England Regional Council Offers Guidance on Effective Management of Type 2 Diabetes

– New Report from New England CEPAC Identifies NPH insulin as a High Value Treatment Option Relative to Costlier, Analog Formulations–

Boston, Mass., December 22, 2014 – The New England Comparative Effectiveness Public Advisory Council (CEPAC), a core program of the Institute for Clinical and Economic Review (ICER), has released a final evidence report, titled “Controversies in the Management of Patients with Type 2 Diabetes.” The report incorporates findings from a recent public meeting of CEPAC, during which council members reviewed evidence on the effectiveness and value of add-on use of certain medications to improve diabetes control, including sulfonylureas and multiple forms of insulin, as well as two relatively new classes of medications, dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. The key findings of the report, along with CEPAC’s votes, suggest that high value treatment options, such as NPH insulin (intermediate-acting human insulin), may be underutilized in many patients.

In evaluating the evidence on different insulin formulations, CEPAC determined that NPH insulin is equally as effective in lowering blood glucose levels as newer insulin analogs and has high value, costing approximately one-third the amount of insulin analogs. Current regional and national practice trends show that insulin analogs are used in approximately 80% of insulin-taking patients with type 2 diabetes, suggesting that NPH may be a significantly underutilized treatment option. In the case of GLP-1 receptor agonists, CEPAC voted that this drug class is more effective than sulfonylureas and insulin due largely to their positive effects on both blood glucose levels and body weight, but that their substantially higher treatment cost makes them a low value option for a majority of patients. CEPAC determined that the current evidence is insufficient to demonstrate the added benefit of DPP-4 inhibitors.

During the meeting, CEPAC also discussed how best to apply the evidence to policy and practice with a panel of regional clinical and policy experts, forming recommendations for ways to promote the use of high value care options while maintaining flexibility for the personalization of treatment based on individual patient needs. The full list of policy recommendations is available in the final report.

In addition to pharmacologic treatments, the final report reviews the evidence on methods for insulin delivery, as well as the potential benefits of continuous blood glucose monitoring in this population. Though these devices may be useful for certain subpopulations of patients, CEPAC voted that current evidence is insufficient to show clinical benefit in type 2 diabetes. The report offers insight into which management approaches provide the best outcomes for patients and how the options compare from a budget impact and cost-effectiveness perspective.

In New England and across the country, the patient, clinical, and policymaker communities have acknowledged the rising prevalence of diabetes and escalating costs associated with its treatment. In 2012, U.S. spending on diabetes totaled nearly $250 billion (CDC, 2014) and is expected to reach $500 billion by 2025 (DAA, 2014). The CEPAC report provides guidance to stakeholders across the health care spectrum confronted with decisions on how to most effectively manage type 2 diabetes.

CEPAC is a regional body whose goal is to provide objective, independent guidance on the application of medical evidence to clinical practice and payer policy decisions across New England. Backed from a consortium of New England state health policy leaders, CEPAC holds public meetings to consider evidence reviews of a range of topics, including clinical interventions and models for care delivery, and provide judgments regarding how the evidence can best be used across New England to improve the quality and value of health care services. ICER manages the day-to-day operations of CEPAC as one of its core programs meant to translate and implement existing evidence reviews to improve their usefulness for patients, clinicians, and payers. For more information about CEPAC, please visit

About ICER
The Institute for Clinical and Economic Review (ICER) is an independent non-profit health care research organization dedicated to improving the interpretation and application of evidence in the health care system. ICER directs two core programs: the California Technology Assessment Forum (CTAF), and the New England Comparative Effectiveness Public Advisory Council (CEPAC).