Overcoming Patient Barriers to Initiating Insulin Therapy in Type 2 Diabetes Mellitus
Section snippets
The Role of Insulin in the Treatment of Type 2 Diabetes
For several years, the treatment paradigm for type 2 diabetes has been to initiate insulin therapy when sulfonylurea therapy fails. However, Wright et al3 found that early addition of insulin to sulfonylurea therapy, that is, when maximal sulfonylurea therapy does not adequately maintain fasting plasma glucose (FPG) levels below target, is a more effective strategy. In this study, patients received insulin therapy if maximal doses of sulfonylurea did not maintain FPG levels <108 mg/dL. The
Resistance to Initiating Insulin Therapy
Despite ample clinical evidence of the efficacy and safety of early insulin therapy in type 2 diabetes, there is still significant reluctance on the part of both providers and patients to begin insulin therapy. Brown et al8 reported that providers wait an average of 27 to 35 months before initiating a change in antidiabetic monotherapy (eg, switching to another agent or adding another agent). From diagnosis, therefore, the average patient accumulates nearly 5 years of glycemic burden (A1C
Patient-Reported Barriers to Initiating Insulin Therapy
As discussed, more than half of the patients interviewed in the DAWN study reported that they were very worried about starting insulin therapy.11, 12 This attitude was consistent across the 13 countries studied. Patients cited several reasons for their reluctance to start insulin therapy—from a genuine fear of needles, hypoglycemia, and weight gain, to personal feelings of guilt or failure, among others.18, 19, 20 All of these barriers may be addressed with appropriate education and counseling (
Conclusions
Early initiation of insulin as add-on therapy to oral antidiabetic agents has been shown to maintain glycemic control for 6 years. Nonetheless, patients and health care providers have concerns about initiating insulin therapy. Patients may have concerns about daily injections, side effects such as hypoglycemia and weight gain, and the complexity of insulin therapy. These fears may be alleviated by presenting insulin as a more flexible option that allows patients to schedule therapy to suit
Acknowledgment
The author wishes to thank Viji Anantharaman for her medical writing and research assistance in the preparation of this manuscript.
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Effectiveness and safety of basal supported oral therapy with insulin glargine, in Japanese insulin-naive, type 2 diabetes patients, with or without microvascular complications: Subanalysis of the observational, non-interventional, 24-week follow-up Add-on Lantus<sup>®</sup> to Oral Hypoglycemic Agents (ALOHA) study
2015, Journal of Diabetes and its ComplicationsCitation Excerpt :Considering various modifiable risk factors of microvascular complications, such as hyperglycemia, duration of diabetes, hypertension, metabolic syndrome, etc. (Abdul-Ghani et al., 2006; Paisey et al., 1984; Ramachandran et al., 1999), and associations among the complications (Girach et al., 2006), it is crucial to prevent microvascular disease, to reduce the associated morbidity and mortality. Increasing awareness and patient/physician education regarding early diagnosis/screening for T2DM and early insulin initiation might help in controlling microvascular complications and related health and economic burden (Marrero, 2007; Peyrot et al., 2005; Spijkerman et al., 2003). An earlier study in Japanese patients shows that 83.4% of T2DM patients have microvascular complications at the time of initiating insulin treatment (Freemantle et al., 2012; Kawamori et al., 2011).
Insulin adherence in patients with diabetes: Risk factors for injection omission
2014, Primary Care DiabetesCitation Excerpt :Therefore, identification of the underlying factors which predispose patients to poor adherence is necessary for better glycemic control. Several studies have been conducted to detect factors associated with insulin adherence, but there is lack of evidence regarding the influence of these factors on adherence to insulin [8,11,12]. In addition there is scarce information about the rate of poor adherence to insulin therapy and related risk factors in developing countries which play a fundamental role in achievement and maintenance of adequate glycemic control [11,13,14].
Trends of insulin use among US adults with type 2 diabetes: The Behavioral Risk Factor Surveillance System, 1995-2007
2012, Journal of Diabetes and its ComplicationsCitation Excerpt :In addition, we observed differences in the proportion of insulin use by race/ethnicity and sex, although the differences tended to diminish over time. Despite the medical benefits of insulin therapy in improving glycemic control and reducing cardiovascular complications, many studies have suggested that there are psychosocial barriers to initiating and maintaining insulin therapy among patients with type 2 diabetes and their health care providers: a fear of needles or injection; misconceptions about the adverse consequences of insulin therapy (e.g., amputation, renal failure) and insulin therapy as a punishment for failure to manage the illness with diet, lifestyle changes, and oral agents; doubt about the efficacy of insulin therapy; and concerns about the side effects of insulin therapy (e.g., hypoglycemia, weight gain) (Davis & Renda, 2006; Marrero, 2007; Peyrot et al., 2005; Polonsky, Fisher, Guzman, Villa-Caballero, & Edelman, 2005). Other studies have suggested that common reasons among patients who began insulin therapy, but stopped using insulin, were fear of insulin injection and a doctor's advice not to use insulin (Oliveria et al., 2007).
Improvements in quality of life associated with insulin analogue therapies in people with type 2 diabetes: Results from the A <inf>1</inf>chieve observational study
2011, Diabetes Research and Clinical PracticeCitation Excerpt :Having to deal with lifestyle change, complex treatment regimens, potentially having to manage self-injection, and sometimes fear of hypoglycaemia and weight gain can contribute to poor QoL and adverse perceptions of diabetes therapies [2–4]. Consequently, people with T2DM and their physicians often delay starting or optimizing insulin therapy, despite the current burdens of poor glycaemic control [4–7]. Alongside effective glycaemic control, maintaining or improving QoL is an integral part of the successful management of diabetes.
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