Barriers to insulin treatment in patients with type 2 diabetes mellitus

Τζιόμαλος, Κωνσταντίνος

doi:10.1080/14656566.2017.1280462

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…However, its high cost, risk of hypoglycemia and weight gain represent substantial barriers to its use[57,58]. …”

Section: Glucose-lowering Agents: Efficacy and Safetymentioning

confidence: 99%

Effects of glucose-lowering agents on ischemic stroke

Avgerinos¹,

Τζιόμαλος²

2017

WJD

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Diabetes mellitus (DM) is a major risk factor for cardiovascular events, including ischemic stroke. Moreover, ischemic stroke appears to be more severe in these patients and to be associated with less favorable outcomes. However, strict glycemic control does not appear to reduce the risk of ischemic stroke. On the other hand, newer glucose-lowering agents (glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors) reduced the risk of cardiovascular events in recent randomized, placebo-controlled trials. Semaglutide also reduced the risk of ischemic stroke. These benefits are independent of glucose lowering and might be due to the favorable effects of these agents on body weight and blood pressure. Pioglitazone also reduced the risk of recurrent stroke in patients with insulin resistance or type 2 DM but the unfavorable safety profile limits its use. In contrast, sulfonylureas and dipeptidyl peptidase 4 inhibitors have a neutral effect on cardiovascular morbidity and might be less attractive options in this high-risk population.

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“…However, its high cost, risk of hypoglycemia and weight gain represent substantial barriers to its use[57,58]. …”

Section: Glucose-lowering Agents: Efficacy and Safetymentioning

confidence: 99%

Effects of glucose-lowering agents on ischemic stroke

Avgerinos¹,

Τζιόμαλος²

2017

WJD

Self Cite

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“…Regular insulin injections can control the progression of diabetes and prevent the occurrence of complications (3)(4)(5)(6). However, injection with a needle are associated with pain and fear in these patients, while repeated use of needles leads to subcutaneous fat hyperplasia, bleeding, and other conditions that ultimately result in treatment interruption, blood glucose control, and quality of life (7,8).…”

Section: Introductionmentioning

confidence: 99%

A self-controlled, cross-over study of intensive insulin treatment with needle-based injection versus needle-free injection in hospitalized patients with type 2 diabetes

Deng

Wang

et al. 2023

Front. Endocrinol.

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Background and AimsNeedle injection and needle-free injection were proven effective in improving glycated hemoglobin (HbA1c) in type 2 diabetes mellitus (T2DM) patients. However, it is unclear if needle-free and needle injections of insulin during intensive insulin therapy in hospitalized patients provide similar efficacy and safety benefits.MethodsA self-controlled cross-over study was conducted on 62 patients with T2DM who received intensive long-acting and short-acting insulin injections with or without needles. The 7-point blood glucose test was performed on the 6th day after insulin administration and the injection method switched on the 7th day of hospitalization. The difference was compared in 7-point blood glucose levels.ResultsThe blood glucose levels at fasting (mean difference=-1.09 ± 2.38mmol/L, 95% CI, -1.69 to -0.48, p=0.0007) and post-breakfast (-1.14 ± 3.02mmol/L, 95%CI, -1.91 to -0.37, p=0.004) were better when patients were receiving needle-free injections compared to when receiving a needle injection. Indeed, daily blood glucose fluctuation, which presented as the area under the curve of glycemia, was decreased in needle-free injection periods (-0.3.48 ± 9.64, 95%CI, -5.95 to -1.01, p=0.0065). There was no significant difference in the dose of long-acting insulin between the two injection methods (-0.32 ± 2.69, 95%CI, -0.99 to 0.37, p>0.05). The dose of fast-acting insulin during the needle-free period was lower than that of when patients received needle injections (-1.66 ± 6.45, 95%CI, -3.29 to -0.025, p<0.05). There was no significant difference in satisfaction between the two regimens (-0.59 ± 1.55,95%CI, -0.938 to 0.509, p=0.557), but there was a significant difference in pain experience, favoring needle-free injections (p < 0.001).ConclusionGlycemia was better controlled by needle-free insulin injections in hospitalized T2DM patients subjected to intensive glycemic control. These patients also experienced less pain than when insulin was injected with a needle.

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“…[4] However, there are several obstacles that lower frequency of use and adherence to insulin therapy, including needle phobia among patients, social stigma linked with insulin injection, errors in dosage adjustment, high costs of insulin, and injection pain. [5, 6] Insulin delivery method (using insulin pens or the traditional way of using vial and syringes) is another contributor to insulin usage in patients with diabetes. Multiple studies showed that insulin pen users take insulin more persistently and as a result, fewer hypoglycemic events compared to insulin vial users are reported in this group.…”

Section: Introductionmentioning

confidence: 99%

Insulin pen use and diabetes treatment goals: A study from Iran STEPS 2016 survey

et al. 2019

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Background Frequency of insulin pen use, despite its higher costs, is increasing to substitute the traditional use of insulin vials. This study aims to report insulin pen use frequency and its associated factors among participants of the STEPS survey 2016 in Iran, which was conducted based on the World Health Organization (WHO) STEPS methodology. Methods In this cross-sectional study, 19,503 (mean age of 46.03±0.13) out of 30,541 participants of the Iran STEPS survey were included (Inclusion criteria: aged >25 years old and availability of their demographic, clinical, and laboratory results for serum glucose, HbA1c, and lipid profile). Clinical and demographic characteristics, a frequency of use of each diabetes mellitus treatment type, and the association of insulin pen use with health outcomes are reported using descriptive analysis and propensity score modeling. Results There were 1,999(10.85%) individuals diagnosed with diabetes in the population, while 1,160(56.87%) cases were taking antihyperglycemic treatments. In this subset, 240(21.14%) individuals administered insulin with or without using oral agents at the same time. 52.28% of participants who were under insulin therapy used insulin pens. None of the socioeconomic determinants, including gender (p-value = 0.11), type of residential areas (p-value = 0.52), years of schooling (p-value = 0.27), wealth index (p-value = 0.19), marital status (p-value = 0.37), and insurance types (p-value = 0.72) were significantly different among groups using insulin pens and insulin vials. Moreover, in the propensity score modeling, pen usage was not associated with a lower heart attack and ischemic stroke histories, systolic blood pressure, serum lipid profile, blood glucose, or HbA1c levels. Conclusion Results showed that the use of the higher-costing insulin pens compared to traditional vials and syringes is not associated with improved glycemic control and better lipid profile in our sample. Future studies are needed to confirm these findings and to compare other aspects of insulin pen use, including adherence to treatment and cost-effectiveness.

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Barriers to insulin treatment in patients with type 2 diabetes mellitus

Cited by 4 publications

References 22 publications

Effects of glucose-lowering agents on ischemic stroke

Effects of glucose-lowering agents on ischemic stroke

A self-controlled, cross-over study of intensive insulin treatment with needle-based injection versus needle-free injection in hospitalized patients with type 2 diabetes

Insulin pen use and diabetes treatment goals: A study from Iran STEPS 2016 survey

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