Insulin prescribing in accordance with the guidelines for type II diabetes: An analysis of billing data of a German statutory health insurance carrier, the Allgemeine Ortskrankenkasse (AOK) Hessen

BACKGROUND: From 2014 onward, the German National Disease Management Guideline (NDMG) for Type II diabetes has recommended a stepwise escalation of insulin therapy, starting with less complex forms of treatment. Hardly any data have been available to date on which insulin therapies were actually prescribed and billed. METHODS: All insulin prescriptions covered by the AOK Hessen in the first two quarters of 2022 that were documented in the database system of the AOK's Scientific Institute were analyzed in this study. A newly developed classification was used to categorize types of insulin therapy. RESULTS: 37 498 insulin prescriptions were identified for 185 069 insurees (20,3 %). Long-acting insulin analogs were prescribed in 25 712 cases (68.6%), most commonly either intensified conventional insulin therapy (37.8%) or basally supported oral therapy (30.8%). Classic forms of treatment, such as supplementary insulin therapy (13.1%), conventional insulin therapy (8.3%), or intermediate-acting insulin at night (2.1%), were less frequently prescribed. CONCLUSION: The NDMG of 2014 and further guidelines that were issued after the end of the period analyzed in this study recommend that insulin therapy should begin with intermediate-acting insulin and/or basally supported oral antidiabetic therapy. The documented prescribing behavior deviates from the guidelines in question and from the guideline issued by the German Federal Joint Committee (G-BA) in 2024. In all but one of the guidelines, intensified conventional insulin therapy is recommended restrictively or only in case of demonstrated absolute insulin deficiency. The analyzed data do not permit any conclusion as to whether insulin was prescribed for proper indications. The care situation indicates that prescribing behavior is partly not in conformity with the guidelines. The analysis had only limited ability to account for complex treatment regimens. There is a need for further research on regional care structures and guideline implementation.