Overcoming patient barriers to initiating insulin therapy in type 2 diabetes mellitus
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Published on: June 11, 2012
1Division of Endocrinology & Metabolism, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. dgmarrer@iupui.edu
Abstract:
Data from clinical trials underscore the fact that loss of beta-cell function and insulin hyposecretion are progressive in type 2 diabetes. To achieve adequate glycemic control, most patients will eventually require insulin. Addition of insulin to sulfonylurea therapy, when maximal sulfonylurea does not adequately maintain fasting plasma glucose levels at <108 mg/dL, has been found to be more effective than initiating insulin therapy after oral agents have failed to maintain glycemic control. Nonetheless, both patients and providers are reluctant to begin insulin therapy. Research has shown that providers often delay modification of the diabetes treatment regimen because they believe their patients would be concerned about starting insulin therapy. In addition, they are concerned about patient nonadherence to nonpharmacologic and pharmacologic therapy. There are multiple reasons for patient nonadherence to insulin therapy; however, patients must be made to understand, early in the course of the disease, the progressive nature of type 2 diabetes and that exogenous insulin is an additional therapeutic option to help them achieve and maintain adequate glycemic control.
Insights
Type 2 diabetes involves progressive beta-cell loss, often necessitating insulin therapy. Early insulin initiation, combined with sulfonylureas, improves glycemic control more effectively than later addition after oral agents fail.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Type 2 diabetes is characterized by progressive loss of beta-cell function and insulin secretion.
- Most patients with type 2 diabetes will eventually require insulin therapy for adequate glycemic control.
Purpose of the Study:
- To evaluate the efficacy of early insulin addition to sulfonylurea therapy versus later insulin initiation.
- To address patient and provider reluctance towards initiating insulin therapy.
Main Methods:
- Analysis of clinical trial data comparing different insulin initiation strategies.
- Review of factors contributing to patient and provider hesitancy in starting insulin.
Main Results:
- Adding insulin to maximal sulfonylurea therapy is more effective than initiating insulin after oral agents fail.
- Patient and provider reluctance stems from concerns about patient adherence and perceived patient concerns about insulin therapy.
Conclusions:
- Early introduction of insulin, particularly in combination with sulfonylureas, is a more effective strategy for managing type 2 diabetes.
- Educating patients on the progressive nature of type 2 diabetes and insulin as a therapeutic option is crucial for improving adherence and outcomes.
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