Incorporating Insulin Earlier for Type 2 Diabetes Patients

Some research has indicated that within 9 years of a type 2 diabetes mellitus (T2DM) diagnosis, a substantial number of patients require insulin to attain a hemoglobin A1c (HbA1c) goal of <7.0%. This has led to speculation and suggestion that clinicians should encourage patients to switch to insulin much earlier in the disease. Doing so might reduce the risk of long-term micro- and macrovascular complications.

The risks of hypoglycemia and modest weight increases factor heavily in the debate, as well. Most experts now urge clinicians to consider insulin from the outset if the patient presents with significant hyperglycemic symptoms and/or if the HbA1c level is between 10% and 12%.

However, fewer than half of patients for whom insulin is recommended actually use it. A study published in the July 2014 issue of the Journal of Multidisciplinary Healthcare identifies practical strategies that can improve uptake of and adherence to insulin therapy.

The authors address clinicians’ medical inertia, recommending they stay informed about new insulin products, emerging technologies, and treatment options. Primary care providers who have smaller practices tend to be more reluctant to initiate insulin therapy than those who see many diabetics. Many physicians cited the time requirement to educate patients on how to use insulin as a significant barrier.

Patients also perceive insulin therapy to be complicated and time-consuming. The authors quote studies that found actively listening to the patient's fears and concerns and educating them about the role of insulin in individualized self-treatment regimens is critical. The investigators advise enlisting help from Certified Diabetes Educators and training office personnel to handle many patient concerns. They also review the literature that describes how newer insulins are more convenient.