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22 September 2011 Last updated at 02:13 GMT By Helen Briggs Health editor, BBC News website 
NHS spending on insulin has been rising Doctors have "wasted" millions on "designer" diabetes drugs when cheaper ones would have been just as effective, according to a report.
The NHS could have saved £625m over 10 years if the older types of insulin recommended in guidelines had been prescribed, claim UK researchers.
The study, published online in BMJ Open, found the NHS spent £2.73bn on insulin, mainly on "designer" forms.
A diabetes charity said patients should have a choice of what insulin to use.
Researchers at Cardiff University found NHS spending on insulin prescriptions in England, Wales, Scotland and Northern Ireland rose from £156m a year in 2000 to £359m in 2009.
Over the same period, annual NHS spending on "designer" insulin increased from £18m (12% of total insulin cost) to £305m (85% of total insulin).
Continue reading the main story Patients with Type 1 diabetes need insulin injections to help their bodies use glucose from meals, as do some people with Type 2 diabetes There are a number of types of insulin available, including animal insulin, human insulin and analogue (designer) insulinsAnimal insulin comes from animals. Human insulin doesn't come from humans but is made in a laboratoryAnalogue insulin is a type of laboratory-made human insulin which is modified to affect how quickly or slowly it actsSource: Diabetes UKBased on the assumption that all patients could have been prescribed alternative forms of insulin, the NHS could have saved itself £625m, said the Cardiff University report.Professor Craig Currie of the Department of Primary Care and Public Health told the BBC: "The regulatory agencies have to get a grip of the way that medicines are chosen and dispensed.
"The decisions aren't informed. The doctors aren't listening to guidelines. The system has to change to use medicines that represent the best value for money."
Pros and consMany patients with diabetes need to inject insulin, to help their body process glucose from food.
There are several types of insulin; including insulin made in the lab to mimic natural insulin (human insulin) and newer laboratory-made human insulins, which have been tweaked to affect the speed of action or enhance certain properties ("designer" insulin, or insulin analogues).
These newer types of insulin may have some advantages for certain patients, such as reducing weight gain and reducing the risk of low blood sugar.
But most experts believe the benefits are modest, the authors said in BMJ Open.
The medicines watchdog NICE recommends that ordinary human insulins are used as a first-line treatment, with the newer "designer" human insulins reserved for exceptional circumstances.
A spokesperson for the Department of Health said: "NICE guidance recommends that human insulin is the preferred option when insulin therapy is necessary in Type 2 diabetes.
"The National Prescribing Centre advises that newer synthetic insulins have a role in treating some patients, but people with glycaemic control problems should be properly assessed for underlying causes before these newer, more expensive insulins are considered."
Simon O'Neill, Director of Care, Information and Advocacy at Diabetes UK, said insulin analogues should be as available to all people with diabetes.
He said: "The decision of which insulin is the most appropriate for a person with diabetes should be made on an individual basis in consultation with the person with diabetes themselves."
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