In June 2010, the drug company Novo Nordisk announced that its only conventional human biphasic insulin, human Mixtard 30, would no longer be available in the UK from January 2011, a decision that affects an estimated 90,000 patients. The alternative biphasic analogue insulins are more expensive than Mixtard 30. Assuming a direct swap to Novo Nordisk's analogue biphasic insulin, NovoMix 30, the increased prescribing costs could be over £9million in England alone. This is quite apart from the extra resources needed to review patients to discuss and decide on alternative treatments, and the disruption and concern such changes may cause for affected individuals. The decision will also mean that biphasic insulin will no longer be available in the ergonomic InnoLet device. Switching to an alternative device could therefore leave many users who have poor eyesight or reduced manual dexterity dependent on others for their insulin administration. The withdrawal of Mixtard 30 will therefore have a major impact on patients, healthcare professionals and healthcare expenditure.

Novo Nordisk has said that it is committed to withdrawing all older types of human insulin over time. While its analogue insulins are marketed as ‘modern insulin’, published evidence shows that biphasic analogue insulins do not offer any advantage over conventional human biphasic insulins in terms of efficacy, long-term outcomes or safety. Yet there are over 50% more prescriptions for NovoMix 30 than for Mixtard 30. The popularity of NovoMix 30 is likely in part to reflect the usability of the FlexPen. And it is possible that the declining use of Mixtard 30 in the UK (the company's stated basis for withdrawing the drug) could have been prevented if it had also been available in the FlexPen. Of note, in Germany, the same drug is available in the Flexpen (as Actraphane 30/70), and there appear to be no plans to withdraw it.

We urge all those with an interest in cost-effective prescribing to campaign with us against Novo Nordisk's short-sighted decision. To find out more, and to sign our online petition, please go to our website (www.dtb.bmj.com).