Barriers to Insulin Progression Among Patients With Type 2           Diabetes

Polinski, Jennifer M.; Smith, Benjamin F.; Curtis, Bradley; Seeger, John D.; Choudhry, Niteesh K.; Connolly, John G.; Shrank, William H.

doi:10.1177/0145721712467696

Cited by 76 publications

(81 citation statements)

References 24 publications

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“…A disconnect between HCP‐perceived and patient‐perceived barriers to titration was also reported in a systematic meta‐analysis performed by Polinski et al; while injection‐related aversions (not assessed in the present survey) and the perceived burden of diseases were identified as barriers to insulin progression (defined by the authors as switching from basal to a premixed insulin regimen, adding bolus doses and/or increasing dosing frequency) for patients, HCPs were concerned about the patients’ ability to handle more complex treatment regimens. Polinski et al also suggested that barriers to insulin titration may be reduced by providing educational interventions to both physicians and patients. Likewise, in the present survey, both HCPs and patients reported that more effective support tools, as well as better HCP understanding of patient needs, were required to assist with BI initiation and titration.…”

Section: Discussionmentioning

confidence: 99%

Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey

Berard

Bonnemaire

Mical

et al. 2017

Diabetes Obesity Metabolism

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AimsBasal insulin (BI) treatment initiation and dose titration in type 2 diabetes (T2DM) are often delayed. Such “clinical inertia” results in poor glycaemic control and high risk of long‐term complications. This survey aimed to determine healthcare professional (HCP) and patient attitudes to BI initiation and titration.MethodsAn online survey (July–August 2015) including HCPs and patients with T2DM in the USA, France and Germany. Patients were ≥18 years old and had been on BI for 6 to 36 months, or discontinued BI within the previous 12 months.ResultsParticipants comprised 386 HCPs and 318 people with T2DM. While >75% of HCPs reported discussing titration at the initiation visit, only 16% to 28% of patients remembered such discussions, many (32%–42%) were unaware of the need to titrate BI, and only 28% to 39% recalled mention of the time needed to reach glycaemic goals. Most HCPs and patients agreed that more effective support tools to assist BI initiation/titration are needed; patients indicated that provision of such tools would increase confidence in self‐titration. HCPs identified fear of hypoglycaemia, failure to titrate in the absence of symptoms, and low patient motivation as important titration barriers. In contrast, patients identified weight gain, the perception that titration meant worsening disease, frustration over the time to reach HbA1c goals and fear of hypoglycaemia as major factors.ConclusionA disconnect exists between HCP‐ and patient‐perceived barriers to effective BI titration. To optimize titration, strategies should be targeted to improve HCP–patient communication, and provide support and educational tools.

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Section: Discussionmentioning

confidence: 99%

Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey

Berard

Bonnemaire

Mical

et al. 2017

Diabetes Obesity Metabolism

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“…An important point to note is that education relies on effective communication to succeed – both between HCPs and between HCPs and patients . For instance, exploring patient beliefs about insulin therapy early in the disease trajectory is key to tackling psychological insulin resistance . Ideally, these discussions would begin at, or soon after, diagnosis and would explain that insulin therapy is ultimately required in the great majority of cases to control the disease and avoid complications.…”

Section: Inertia With Initiation Of Insulin Treatmentmentioning

confidence: 99%

Identification of barriers to insulin therapy and approaches to overcoming them

Russell‐Jones

Pouwer

Khunti

2017

Diabetes Obesity Metabolism

193

161

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Poor glycaemic control in type 2 diabetes (T2D) is a global problem despite the availability of numerous glucose‐lowering therapies and clear guidelines for T2D management. Tackling clinical or therapeutic inertia, where the person with diabetes and/or their healthcare providers do not intensify treatment regimens despite this being appropriate, is key to improving patients’ long‐term outcomes. This gap between best practice and current level of care is most pronounced when considering insulin regimens, with studies showing that insulin initiation/intensification is frequently and inappropriately delayed for several years. Patient‐ and physician‐related factors both contribute to this resistance at the stages of insulin initiation, titration and intensification, impeding achievement of optimal glycaemic control. The present review evaluates the evidence and reasons for this delay, together with available methods for facilitation of insulin initiation or intensification.

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“…Less attention has been paid to inertia in the intensification of insulin therapy but many of the same needs are apparent. 11,17 Intensification is widely perceived as the "preserve of specialists", 16 in part because there are no guidelines that specifically address the intensification of insulin therapy from basal-only to basal-bolus.…”

Section: Insulin Use -Trends and Barriersmentioning

confidence: 99%

“…Injection-related concerns are diminished in those with insulin experience, 17 but appropriate progression of treatment is frequently delayed in practice. 11 Physicians' concerns about complex insulin regimens include their patients' coping abilities, but they also worry whether they themselves have sufficient understanding of the requirements, including how best to help their patients through the process.…”

Section: Barriers To Insulin Intensificationmentioning

confidence: 99%

Management of Type 2 Diabetes – Methods for Addition of Prandial to Basal Insulin

Rodbard¹,

Karolicki²

2014

US Endocrinology

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As glycaemic control deteriorates with the progression of type 2 diabetes, treatment guidelines advocate starting basal insulin therapy, and then progressing to a basal-bolus regimen as needed. Nevertheless, although timely intensification of therapy is important to minimise the risk of diabetic complications, considerable clinical inertia exists, not only in the initiation of insulin but also in the progression to multiple-dose insulin regimens. One barrier has been the lack of guidance about how to make the transition from basal-only to basal-bolus insulin therapy.In this review, we discuss how data from the recent FullSTEP study, along with other randomised studies, will help to bridge this gap. Prandial boluses can be added to basal insulin in a stepwise manner, using a straightforward, patient-led dose titration approach and simple estimation of which meal to add the initial prandial bolus to. Reducing the complexity of progression to multiple-dose insulin regimens and empowering patients will lessen the burden on clinicians, improve treatment satisfaction and facilitate timely implementation of treatment guidelines.

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Barriers to Insulin Progression Among Patients With Type 2 Diabetes

Cited by 76 publications

References 24 publications

Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey

Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey

Identification of barriers to insulin therapy and approaches to overcoming them

Management of Type 2 Diabetes – Methods for Addition of Prandial to Basal Insulin

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