California's insulin plan, clinical decision support in lower-income countries

Recent articles from Annals of Internal Medicine discussed California's plan to produce insulin and a diabetes clinical decision support system that may be helpful in primary care in low- to middle-income countries.

Diabetes care was the focus of two recent articles from Annals of Internal Medicine.

An Ideas and Opinions article published Nov. 15 reported on California's July announcement of the CalRx Biosimilar Insulin Initiative. The state intends to develop, manufacture, and distribute its own biosimilar insulin products at a significantly lower price than those currently available. The project, which is expected to begin providing insulin in the next two to three years, will disrupt the market by selling insulin at transparent, low prices that are close to the cost of production and by partnering with health plans to create a market for the state-produced insulin, the authors explained. “This can be the beginning of a system that breaks from the current model where supply chain participants profit off rebates and price concessions negotiated for insurers,” they wrote. “The success of the CalRx Biosimilar Insulin Initiative will lay the groundwork for future targets, such as other biologic and nonbiologic drugs.”

A study published on Dec. 6 reported on the results of implementing a computerized clinical decision support system in community health centers in Xiamen, China. The system provided individualized treatment recommendations based on clinical guidelines for patients ages 50 years or older with uncontrolled diabetes and comorbid conditions. It was implemented in 19 centers, along with team-based care by primary care physicians, health coaches, and diabetes specialists, while a control group of 19 centers only implemented the team model. During the 18-month intervention, HbA1c levels, low-density lipoprotein cholesterol levels, and systolic blood pressure decreased in both groups, but by slightly more with the decision support. The proportion of patients with all three measures controlled was 16.9% (95% CI, 15.7% to 18.2%) with the decision support and 13.0% (95% CI, 11.7% to 14.3%) with team-based care alone. The authors concluded that the intervention “significantly reduced cardiovascular risk factors in patients with diabetes, but the effect was modest.”