Expert Opinion: A Call for Basal Insulin Titration in Patients with Type 2 Diabetes in Daily Practice: Southeast European Perspective

Abstract

Therapeutic inertia related to insulin treatment, i.e. delays in initiation, especially titration of basal insulin, is a significant problem in daily practice in Southeast European countries. This phenomenon can be traced back to several patient-, physician- and health system-related factors. In recognition of the issue of inadequate insulin titration, 11 leading experts from countries in this region held a consensus-seeking meeting to review the current status of insulin initiation after non-insulin treatment and the potential barriers to insulin titration to provide an algorithm and tools for outpatient physicians and for patients aimed at optimizing basal insulin titration. The experts reached a consensus on the majority of the topics and proposed recommendations on how clinical inertia can be overcome. The outcomes of the meeting have been summarized in this paper.

Practical Guidance on Basal Insulin Initiation and Titration in Asia: A Delphi-Based Consensus

“…To ensure the same, every effort should be made to increase patient awareness and education to empower patients to self-titrate insulin. Similar recommendations were provided in a Southeastern European consensus [ 27 ].…”

“…Clinical inertia related to insulin therapy, typically manifested as a delay in insulin initiation and titration, is a well-acknowledged concern in routine clinical practice [ 27 ]. Commonly insulin initiation is delayed because both the physicians and patients are subject to misconceptions and fears about the progression of diabetes and the role of insulin [ 28 ].…”

“…People with diabetes should be educated and trained on how and when to practice SMBG. Additionally, patients should be advised to continue the initial dose of insulin, unless instructed by the physician to start titration [ 27 ].…”

“…To ensure the same, every effort should be made to increase patient awareness and education to empower patients to self-titrate insulin. Similar recommendations were provided in a Southeastern European consensus [27]. Since patient involvement is well recognized as a key factor in glycemic management, the experts proposed a customizable stepwise insulin titration algorithm to guide the patient.…”

Challenges in Insulin Therapy for Type 2 Diabetes

“…In the manuscript ''Expert Opinion: A Call for Basal Insulin Titration in Patients with Type 2 Diabetes in Daily Practice: Southeast European Perspective'', Nicolae Hancu and colleagues have devised a set of clinical guidelines to overcome the shortcoming of insulin therapy [1]. I commend the group for identifying the topic as a major population health deficiency which calls for urgent solutions.…”