When oral agents fail: practical barriers to starting insulin

The purpose of this review is to address patient- and provider-related factors that contribute to psychological insulin resistance’ and to identify mechanisms by which these barriers can be overcome

M Korytkowski


Scholarcy highlights

  • A large percentage of individuals with Type 2 diabetes will eventually require exogenous insulin therapy to achieve and maintain recommended targets for glycaemic control
  • Current strategies for treating Type 2 diabetes include the administration of a single oral agent when lifestyle intervention with diet and exercise regimens are not sufficient to maintain HbA1C < 7%
  • Despite the demonstrated efficacy of insulin therapy in achieving and maintaining glycaemic control in people with Type 2 diabetes, there is both a spoken and unspoken reluctance from both physicians and patients to initiate this form of therapy
  • This reluctance to initiate insulin therapy in a timely manner contributes to prolonged periods of poor glycaemic control among individuals with Type 2 diabetes and increases the risk for neuropathic, microvascular and macrovascular complications
  • Patient factors contributing to a poor sense of wellbeing included: anxiety about body weight; fear that their disease would worsen; fear of hypoglycaemic events; and fear among patients with Type 2 diabetes that they would eventually require insulin
  • There was no significant difference in the metabolic control of patients on inhaled insulin compared with injected insulin
  • Studies of new insulin analogues, such as the rapid-acting insulin aspart, in Type 1 diabetes suggest that their use can improve postprandial control and glucose excursions in general, and at the same time reduce the likelihood of major hypoglycaemic episodes in comparison to traditional human insulin-based regimens
  • Improving insulin products and devices that overcome these barriers and enhancing healthcare services can together address psychological insulin resistance and contribute enormously to the maintenance of good metabolic control

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