Journal Article

Insulin Therapy for Type 2 Diabetes: Social, Psychological, and Clinical Factors

Hui Yu Kuang Permanente Greater Southern Alameda Area, Sumera Ahmed-ADM Professor and Diabetologist University California College of Osteopathic Medicine, Jay H Shubrook-ADM and Diabetologist University California College of Osteopathic Medicine, Clipper F Young-ADM Professor and Clinical Pharmacist University California College of Osteopathic Medicine, Joy Dugan-C Program Director/Associate Professor University California Joint MSPAS/MPH Program

2019

Overview

Both the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) recommend that patients with type 2 diabetes should have therapy titrated and/or intensified every three months and should be started on insulin therapy within nine months after being treated with oral medications if their blood glucose levels are not at goal.1,2 Some studies have shown that using insulin as the initial treatment strategy for type 2 diabetes can provide a period of diabetic euglycemia or remission.3,4 Despite the well-established clinical treatment guidelines and research findings advocating the use of insulin as the initial agent after the diagnosis, early insulin initiation or insulin intensification as recommended does not occur often enough during medical appointments. [...]it is important to have strategies for clinicians to overcome any barriers that are prohibiting the provision of insulin therapy to patients. Because of the long-acting component, insulin degludec has an ultra-long half-life of ~25 hours; this insulin combination matches those who have irregular schedules, leading to less than optimal adherence to injection, and who are on a basal-plus-one or basal-plus-two insulin regimen who wish to reduce the injection burden.32 In a clinical trial comparing degludec/aspart combination and biphasic aspart in uncontrolled type 2 diabetes patients, researchers found that degludec/aspart given twice daily was more effective in reducing HbA1c levels and fasting blood glucose levels.33 This combination also has been shown to result in fewer episodes of hypoglycemia. Because of the GLP-1 RA component, both products carry a boxed warning for the risk of thyroid c-cell tumors and are contraindicated in patients with a history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2).47,48 Both products are available in a pen device with a display showing even dose steps for dosing purposes.

• Publisher: Relias Learning
• Subject: Blood / Blood glucose / Diabetes / Diabetes mellitus / Diabetes mellitus (non-insulin dependent) / Display devices / Drug therapy / Fear & phobias / Glucose / Hyperglycemia / Hypoglycemia / Injection / Insulin / Multiple endocrine neoplasia / Neuroendocrine tumors / Nutrition / Patients / Pharmacists / Remission / Schedules / Systematic review / Therapy / Thyroid / Thyroid cancer / Thyroid carcinoma / Tumors