Glycemic control amongst diabetic subjects on insulin therapy: Still off target!

Abstract

Introduction:Prevalence of diabetes is increasing worldwide. Good glycemic control is essential for prevention of complications of diabetes. Despite of availability of multiple medications, it is difficult to achieve good glycemic control. Insulin therapy is considered to be the best option available for attaining glycemic control. But, whether insulin therapy has achieved it is an important question to be addressed. Objective: To assess the glycemic control in subjects with diabetes on insulin therapy. Materials and Methods: A cross-sectional study was done at Karnataka Institute of Endocrinology and research, Bangalore, in 448 diabetic patients who were on insulin therapy as a part of their diabetic therapy. Data collected was analyzed using SPSS 22 version software. Results: Majority of the subjects were men (61.38%) and in the age group of > 60 years (44.9%). Many of the subjects on insulin therapy had duration of diabetes > 5 years, with 36.4% having duration of 10-20 years, while another 36% had duration of 5 -10 years. Premixed insulin (81.47%) was the most commonly used insulin regimen. 82.6% of the subjects were on conventional insulin and only 13.2% were on insulin analogues. Insulin syringe was the most commonly used delivery device, with 64.7% of subjects using it, while insulin pen was used by 33.5% subjects. Despite of insulin therapy, the glycemic control was poor and 81.4% had HbA1c >8%. Only 5.7% of the subjects had HbA1c <7%. 94.9% of the subjects reported that they were regular with their insulin therapy. Only 20.1% adjusted the insulin dose by self. Conclusions: The present study has found that despite being on insulin therapy, large percentage of subjects was unable to achieve good glycemic control.

Knowledge, attitude and practices of insulin therapy among patients with type 2 diabetes: a cross-sectional study

“…Several studies have demonstrated that patients with type 2 diabetes have a gap in knowledge, a negative attitude and incorrect practices regarding insulin therapy 15 18–22. However, the present study’s findings showed that patients with type 2 diabetes receiving insulin therapy have adequate knowledge, positive attitudes and correct practices regarding their insulin therapy.…”

“…The present study participants (42%) reported that injecting insulin is painful. Similarly, Shetty et al 25 found that 49.9% of their participants (n=448) felt that insulin injections are painful. Furthermore, Fu et al 17 found that 66.9% of their study participants (n=306) had a negative attitude towards insulin therapy as injecting insulin is painful.…”

“…Ebrahim et al 15 reported that only 4% of their study participants (n=100) disposed used insulin needles in a special container. Shetty et al 25 also reported that 98.2% (n=440) and 1.2% (n=8) disposed both used insulin pens and needles in the general waste and medical waste, respectively.…”

On the path to a diabetes cure: a critical appraisal of developments in pancreatic beta cell encapsulation and implantation

“…In this way, it is sought to mimic pancreatic physiological function and thus achieve better results (American Diabetes Association Professional Practice Committee, 2022). However, despite being the "gold standard" in the treatment of T1D and T2D with advanced beta secretory failure, exogenous insulin therapy has been associated with adverse effects such as weight gain, lipoatrophy, hyperlipotrophy, skin infections, hypoglycemia (Demir et al, 2022;Guarneri and Hoffman, 2022;Amiel, 2021), and even therapeutic failure in a considerable percentage of patients (Al-Qerem et al, 2022;Sherwood et al, 2020;Shetty and Ramachandrappa, 2019;Alzaheb and Altemani, 2018). As a result, efficient therapeutic strategies have been developed in recent decades to effectively control these disorders and restore endogenous insulin production (Posselt et al, 2010).…”