When oral agents fail: practical barriers to starting insulin

Insulin therapy has proven benefits in Type 2 diabetes patients when combination therapy has failed. However, there is some reluctance by both patients and healthcare professionals to initiate insulin therapy. This reluctance has been termed ‘psychological insulin resistance’. Barriers to the initiation of insulin therapy include patients‘ fear of disease progression and needle anxiety; mutual concerns about hypoglycaemia and weight gain; and health professionals' use of insulin as a threat to encourage compliance with earlier therapies. It is essential that these obstacles are identified and investigated as a means of overcoming these impediments to recommended levels of glycaemic control, an initiative being pursued by the DAWN study. Where concerns are tangible, such as fear of hypoglycaemia, therapeutic solutions can be pursued. Overcoming psychological barriers relies more on innovative management techniques. Improving insulin delivery to meet these needs, coupled with enhanced healthcare services, can address psychological insulin resistance and contribute to the maintenance of good metabolic control.

[1]  J. Levy,et al.  U.K. Prospective Diabetes Study 16: Overview of 6 Years' Therapy of Type II Diabetes: A Progressive Disease , 1995, Diabetes.

[2]  F J Snoek,et al.  Symptoms and Well-Being in Relation to Glycemic Control in Type II Diabetes , 1996, Diabetes Care.

[3]  K. Flegal,et al.  Racial and ethnic differences in glycemic control of adults with type 2 diabetes. , 1999, Diabetes care.

[4]  F. Nuttall,et al.  Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes (VA CSDM): Results of the feasibility trial , 1995, Diabetes Care.

[5]  J. Pugh,et al.  NIDDM Patients' Fears and Hopes About Insulin Therapy: The basis of patient reluctance , 1997, Diabetes Care.

[6]  F J Snoek,et al.  Diabetes Fear of Injecting and Self-Testing Questionnaire: a psychometric evaluation. , 2000, Diabetes care.

[7]  J. Hörnquist,et al.  Insulin-pen treatment, quality of life and metabolic control: retrospective intra-group evaluations. , 1990, Diabetes research and clinical practice.

[8]  P. Home,et al.  Improved glycemic control with insulin aspart: a multicenter randomized double-blind crossover trial in type 1 diabetic patients. UK Insulin Aspart Study Group. , 1998, Diabetes care.

[9]  A. Lindholm,et al.  Insulin aspart vs. human insulin in the management of long‐term blood glucose control in Type 1 diabetes mellitus: a randomized controlled trial , 2000, Diabetic medicine : a journal of the British Diabetic Association.

[10]  W. Cefalu,et al.  Efficacy of inhaled human insulin in type 1 diabetes mellitus: a randomised proof-of-concept study , 2001, The Lancet.

[11]  K. Malmberg.  Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus , 1997, BMJ.

[12]  Peter Bjerring,et al.  Pain and mechanical injury of human skin following needle insertions , 1999, European journal of pain.

[13]  Beverley Balkau,et al.  High Blood Glucose Concentration Is a Risk Factor for Mortality in Middle-Aged Nondiabetic Men: 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study , 1998, Diabetes Care.

[14]  K. Yano,et al.  Glucose intolerance and 23-year risk of coronary heart disease and total mortality: the Honolulu Heart Program. , 1999, Diabetes care.

[15]  G. Alberti.  The DAWN (Diabetes Attitudes, Wishes and Needs) study , 2002 .

[16]  B. Balkau,et al.  Is there a glycemic threshold for mortality risk? , 1999, Diabetes care.

[17]  J Herlitz,et al.  Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. , 1995, Journal of the American College of Cardiology.

[18]  Uk-Prospective-Diabetes-Study-Group.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[19]  T. Cvetković,et al.  Quality of Life in Type 2 Diabetic Patients , 2014 .

[20]  C. Sachon,et al.  Phobic Symptoms, Particularly the Fear of Blood and Injury, Are Associated With Poor Glycemic Control in Type I Diabetic Adults , 1997, Diabetes Care.

[21]  D. Donaldson,et al.  Is continued weight gain inevitable in type 2 diabetes mellitus? , 1999, The journal of the Royal Society for the Promotion of Health.

[22]  W. Cefalu,et al.  Inhaled Human Insulin Treatment in Patients with Type 2 Diabetes Mellitus , 2001, Annals of Internal Medicine.

[23]  W. Manning,et al.  Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications, and resource utilization. , 1997, JAMA.

[24]  Lawrence A Leiter,et al.  Use of insulin aspart, a fast-acting insulin analog, as the mealtime insulin in the management of patients with type 1 diabetes. , 2000, Diabetes care.

[25]  R. Newson,et al.  Injection related anxiety in insulin-treated diabetes. , 1999, Diabetes research and clinical practice.

[26]  A. Kadiri,et al.  Comparison of NovoPen 3 and syringes/vials in the acceptance of insulin therapy in NIDDM patients with secondary failure to oral hypoglycaemic agents. , 1998, Diabetes research and clinical practice.

[27]  M. Vanderpump,et al.  Insulin Regimens for the Non‐insulin Dependent: Impact on Diurnal Metabolic State and Quality of Life , 1994, Diabetic medicine : a journal of the British Diabetic Association.

[28]  R. Heine,et al.  Phobia of self‐injecting and self‐testing in insulin‐treated diabetes patients: opportunities for screening , 2001, Diabetic medicine : a journal of the British Diabetic Association.