Jennifer Green, MD: Initiating, Accessing and Adjusting Insulin for Type 2 Diabetes

Last month, diabetes experts and specialists from the Duke Health collaborated with HCPLive on a State of the Science Summit program titled, “Institutional Perspectives in Type 2 Diabetes: Contemporary Approaches to Insulin Treatment.”

The paneled presentation was led by chair Jennifer Green, MD, diabetologist and professor of medicine at Duke University Medical Center. In an interview with HCPLive, Green discussed some of the key topics of discussion at the program, including the role of insulin as a “foundation or fundamental of care in type 2 diabetes” amid an era of evolving care strategies and advancing treatment options.

“I think it’s really important to remember that people are developing type 2 diabetes at younger and younger ages, and they are living many more years with type 2 diabetes than we have seen in the past,” Green said. “And we know that the longer a person has type 2 diabetes, the greater the chances are they’re going to need insulin at least as a component of their glucose management regimen.”

Green also discussed initiating insulin treatment, and the specificity of parameters that go into such a decision for the average patient.

“Many people, by the time they are diagnosed with type 2 diabetes, have a very high hemoglobin A1C, they have symptoms related to hyperglycemia, and it is always appropriate to think of insulin therapy right off the bat for someone in that situation,” she said.

After reviewing specific cases of patients with acute illness, pregnancy or concomitant steroid treatment, Green reviewed access and cost-effective strategies for the costly drug, as well as the rationale behind treatment intensification or modification.

“I don’t think there’s a one-size-fits-all, but when you’re talking about outpatient, usual clinical care where there isn’t an urgent need to start insulin, you can always think about…incorporating insulin as part of your approach to getting that person’s control much closer to what’s optimal to them,” Green said. “But there’s really no hard and fast rule.”