Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy

Leto, Gaetano; Barchetta, Ilaria; Candia, Lorenzo De; Magotti, Maria Grazia; Cianciullo, Marco; Manti, Roberta; Negri, Carlo; Cimino, Vincenzo; Dodesini, Alessandro Roberto; Zerella, Francesco; Baratta, Roberto

doi:10.1007/s13300-021-01137-4

Diabetes Ther

2021

DOI: 10.1007/s13300-021-01137-4

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Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy

Gaetano Leto

Ilaria Barchetta

Lorenzo De Candia³

et al.

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2023

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Cited by 2 publications

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Issues of insulin therapy for type 2 diabetes and ways to solve them

Katerenchuk

2023

Mìžnarodnij endokrinologìčnij žurnal

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The article is a summary of personal experience and literature data from PubMed, Scopus, Web of Science, ClinicalTrials.gov databases. As a result of the analysis, the main problems faced by practical endocrinologists when administering insulin therapy to patients with type 2 diabetes mellitus (T2DM) have been determined. Insulin therapy remains an important component of glucose-lowering therapy in T2DM. A significant increase in the number of oral hypoglycemic agents has allowed delaying the start of insulin therapy but the treatment for T2DM without insulin is not real today. The current problems of insulin therapy are as follows: untimely start, insufficient titration of the dose of basal insulin, excessive use of basal and bolus insulins, the irrationality of the use of premixes and the basis bolus regimen of insulin therapy. There are methods to overcome each of these issues that have proven their effectiveness according to clinical trials and real clinical practice data. The combination of insulin and oral therapy plays an important role, the addition of oral hypoglycemic agents is effective at different stages of insulin therapy. One of the most promising options is the use of fixed combinations of basal insulin with glucagon-like peptide-1 receptor agonists. Fixed combinations can be used as initial therapy and are often the first step when changing other insulin therapy regimens. The use of fixed combinations can be an option for modification (simplification) of complex insulin therapy regimens, including the basal bolus regimen. Authors review current evidence and circumstances in which insulin can be used, consider individualized choices of alternatives and combination regimens, and offer some guidance on personalized targets and approaches to glycemic control in type 2 diabetes. In general, most of the modern problems of insulin therapy have options for successful overcome.

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Issues of insulin therapy for type 2 diabetes and ways to solve them

Katerenchuk

2023

Mìžnarodnij endokrinologìčnij žurnal

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Therapeutic Inertia and Delays in Insulin Intensification in Type 2 Diabetes: A Literature Review

2023

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BACKGROUND Therapeutic inertia leading to delays in insulin initiation or intensification is a major contributor to lack of optimal diabetes care. This report reviews the literature summarizing data on therapeutic inertia and delays in insulin intensification in the management of type 2 diabetes. METHODS A literature search was conducted of the Allied & Complementary Medicine, BIOSIS Previews, Embase, EMCare, International Pharmaceutical Abstracts, MEDLINE, and ToxFile databases for clinical studies, observational research, and meta-analyses from 2012 to 2022 using search terms for type 2 diabetes and delay in initiating/intensifying insulin. Twenty-two studies met inclusion criteria. RESULTS Time until insulin initiation among patients on two to three antihyperglycemic agents was at least 5 years, and mean A1C ranged from 8.7 to 9.8%. Early insulin intensification was linked with reduced A1C by 1.4%, reduction of severe hypoglycemic events from 4 to <1 per 100 person-years, and diminution in risk of heart failure (HF) by 18%, myocardial infarction (MI) by 23%, and stroke by 28%. In contrast, delayed insulin intensification was associated with increased risk of HF (64%), MI (67%), and stroke (51%) and a higher incidence of diabetic retinopathy. In the views of both patients and providers, hypoglycemia was identified as a primary driver of therapeutic inertia; 75.5% of physicians reported that they would treat more aggressively if not for concerns about hypoglycemia. CONCLUSION Long delays before insulin initiation and intensification in clinically eligible patients are largely driven by concerns over hypoglycemia. New diabetes technology that provides continuous glucose monitoring may reduce occurrences of hypoglycemia and help overcome therapeutic inertia associated with insulin initiation and intensification.

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Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy

Cited by 2 publications

References 59 publications

Issues of insulin therapy for type 2 diabetes and ways to solve them

Issues of insulin therapy for type 2 diabetes and ways to solve them

Therapeutic Inertia and Delays in Insulin Intensification in Type 2 Diabetes: A Literature Review

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