The incidence of type-2 diabetes is increasing worldwide and appropriate and timely methods of management are often debated.
Eventually most patients with type-2 diabetes require insulin to achieve or maintain their ideal HbA1c, however patient concerns and problems with adherence remain.
A recent study by a group of multidisciplinary diabetes experts, who are members of a diabetes consensus group, looked specifically at diabetes care in primary care. They found that while insulin is the most effective treatment in type-2 diabetes, its use remains challenging and time consuming, especially at the time of insulin initiation in primary care.1
They also acknowledged that late insulin initiation may be the result of a lack of consensus between national and international guidelines regarding glycaemic targets and recommendations for optimal diabetes management.
The authors found that empowering patients through education and self-management is key to improving adherence to insulin therapy and achieving effective long-term glycaemic control. They emphasised the need for developing new insulins with better medication adherence profiles and improved dose flexibility, as well as reduced risk of hypoglycaemia and weight gain and reduced frequency of monitoring and dose adjustment.
Improving insulin therapy adherence
- Involve patients in treatment decisions to enhance patient self-management. This improves treatment adherence, glycaemic control and patient quality of life.
- Help patients become knowledgeable about their disease by ensuring you provide information during the consultation. The authors also suggest that providing reading materials, online resources or even structured educational programmes is beneficial but they acknowledge that these approaches are more resource intensive.
- Understand the patient's priorities and how to make treatments more acceptable.
- Strategies, such as providing detailed patient information, counselling, reminders and close follow-up, are successful but, again, involve frequent patient interactions and resources.
The researchers concluded that a similar approach could be applied to other chronic diseases with an emphasis on resource management, empowering patients and improving adherence to therapy.
1. Brunton S, Gough S, Hicks D et al. A look into the future: improving diabetes care by 2015. Curr Med Res Opin 2011; 27: S3, 65-72.
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