Why Insulin? Addressing Social and Psychological Barriers

In patients with type 2 diabetes, researchers have found that starting insulin as the initial treatment strategy provides the best outcomes. More than 30 million Americans, including about 12 million seniors, live with diabetes, according to the Centers for Disease Control and Prevention.

As providers and patients address social and psychological barriers to effectively starting insulin therapy, they also can be confused by the increasing number of available insulin products. In the January issue of Primary Care Reports, Clipper Young, PharmD, and his coauthors provide a comprehensive review of currently approved insulin products. In addition, they recommend strategies that primary care clinicians can use to initiate and intensify insulin therapy and ultimately improve diabetes management for patients.

Earlier this week, the American Diabetes Association (ADA) released its 2019 updated clinical guidelines on caring for patients with diabetes. “Standards of Medical Care in Diabetes” includes the ADA’s latest recommendations on clinical care, treatment goals, and improving patient health outcomes.

Key updates in the 2019 guidelines include:

• The addition of a section on the use of telemedicine to deliver health-related information to patients with diabetes;
• An expanded description on techniques for injection insulin and the importance of appropriate dosing;
• The recommendation of glucagon-like-peptide 1 receptor agonists as the first treatment option in patients with type 2 diabetes;
• The importance of re-evaluating glycemic targets over time;
• Individualized meal planning strategies and the importance of increasing water consumption and decreasing consumption of sugar-sweetened and non-nutritive-sweetened beverages.

“The choices for insulin therapy are ever increasing with the development of new products that provide greater flexibility, greater range of effectiveness, lower risk of hypoglycemia, and lower pharmacokinetic and pharmacodynamic variability,” says Gregory R. Wise, MD, editor of Primary Care Reports. “In addition, the recently published ADA guidelines provide evidence-based interventions to improve outcomes within the exploding epidemic of diabetes.”