Identification of barriers to insulin therapy and approaches to overcoming them

Abstract

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.

The effect of hypoglycaemia during hospital admission on health‐related outcomes for people with diabetes: a systematic review and meta‐analysis

“…Hypoglycaemia and fear of potential hypoglycaemia remain a major barrier for healthcare professionals when supporting people with diabetes in hospital to achieve optimal glucose control . Inadequate education and clinical knowledge about the risks associated with and strategies for prevention of hypoglycaemia in hospitalized people, may contribute to the suboptimal inpatient diabetes management documented by successive National Inpatient Diabetes Audits .…”

Hypoglycaemia and treatment patterns among insulin‐treated patients with type 2 diabetes who switched to insulin glargine 300 units/mL versus other basal insulin in a real‐world setting

“…Many of the symptoms of hypoglycaemia, such as weakness, dizziness and rapid heartbeat, may be particularly challenging for elderly individuals by adding to an already increased risk for falls, cognitive impairment and other complications . Even among patients with T2D who initiate basal insulin, it is estimated that only 30% achieve their individual glycemic target, in part due to concerns around hypoglycaemia which may result in less timely and effective insulin titration . It has also been shown that hypoglycaemia leads to poor adherence and clinical outcomes, concurrent with increased healthcare resource use .…”

Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis

“…Both poor A1C target attainment and A1C plateau may be due to insufficient insulin intensification. This reluctance to intensify insulin regimens may be due to factors including fear of hypoglycaemia, weight gain, burdensome regimens, or cost . In this regard, currently available second‐generation BIs have sought to reduce hypoglycaemia risk without compromising A1C reduction; however, it remains to be determined whether these novel insulins (eg, insulin glargine 300 units/mL and insulin degludec) will overcome such reluctance to intensify insulin therapy.…”