Early insulin therapy in patients with type 2 diabetes mellitus

Abstract

Type 2 diabetes mellitus (T2DM) is a progressive disease characterised by beta cell dysfunction and insulin resistance. Beta cell dysfunction progresses to beta cell failure. Many patients with T2DM are managed with oral agents until complications develop. 'Clinical inertia' in T2DM, defined as lack of initiation or intensification of therapy when clinically indicated, is common among clinicians. Patients are exposed to hyperglycaemia for a long time resulting in glucotoxicity to beta cells, leading to further beta cell deterioration. The traditional approach to the management of T2DM is lifestyle change, diet, exercise, weight loss, oral agents and, lastly, insulin. This traditional approach is usually carried out step-by-step and at a slow pace, with insulin offered as a last option. By the time insulin therapy is initiated, complications have already developed. It is, therefore, important for clinicians to be aware of the importance of initiating insulin therapy early to prevent poor glycaemic control and the development of diabetes-related complications.

Insulin therapy is a personalized approach to glycemic management in diabetes

“…Therapeutic Archive. 2020; 92 (12): 201-206. DOI: 10.26442/00403660.2020.12.200449 HbA 1c -гликированный гемоглобин ВГ -вариабельность гликемии ПССП -пероральные сахароснижающие препараты СД -сахарный диабет СКГ -самоконтроль уровня гликемии СКФ -скорость клубочковой фильтрации ХЕ -хлебные единицы Т.Ю.…”

Key Strategies for Overcoming Psychological Insulin Resistance in Adults with Type 2 Diabetes: The UK Subgroup in the EMOTION Study

“…Disease progression, and specifically poor glycaemic control, eventually results in several debilitating and/or life-threatening complications [2,3]. Early initiation of insulin in T2DM is important in order to address poor glycaemic control and prevent the development of diabetes-related complications [4].…”

Successful Health Care Provider Strategies to Overcome Psychological Insulin Resistance in United States and Canada

“…1,3 Treatment with insulin is associated with higher rates of achieving adequate glycemic control, and early use of insulin can significantly lower the risks of long-term complications associated with T2D. [4][5][6][7][8] Despite the demonstrated efficacy of insulin, a significant portion of T2D patients are reluctant to initiate insulin. For example, a 2017 study revealed that nearly 30% of patients with T2D originally refused to start insulin when recommended by their health care provider (HCP) and there was a significant delay (up to 2 years) among patients that did eventually begin therapy.…”