Insulin is underused in the United States and has traditionally been recommended as the last option in the sequential treatment algorithm of type 2 diabetes mellitus. Healthcare practitioners are often reluctant to initiate insulin therapy because of patient concerns about the use of injections, side effects, inconvenience of injections, embarrassment, lifestyle restriction, and social stigma. Instead, clinicians should encourage patients to incorporate insulin into their diabetes therapy when it is appropriate, particularly now that new insulin formulations and delivery methods have demonstrated effectiveness in getting patients to achieve their glycemic goals. Toward that end, guidelines now suggest consideration of insulin as part of a first-line regimen. The goals of this initiative include getting patients off to a good start with insulin therapy with effective insulin conversation, education, titration, and follow-up support; overcoming the phenomenon known as “psychological insulin resistance”; and addressing therapeutic inertia, which is defined as a failure to initiate or intensify therapy in a timely manner according to evidence-based clinical guidelines.
Back to Insulin Basics: Solidifying Strategies to Overcome Barriers and Improve the Insulin Initiation Experience
As new insulin products continue to be introduced into the market, pharmacists are challenged to understand their place in diabetes therapy. This educational activity will cover insulin “basics” and review the clinical profiles of current insulin products with regard to dosing, variability, volume, and safety. Best practices for initiating insulin therapies will be reviewed. Barriers to optimal therapy, including psychological insulin resistance and clinical inertia will also be addressed.
Clinical Case Studies: Effective Strategies for Improving Insulin Initiation and Overcoming Barriers to Insulin Therapy
Cooperation of all stakeholders—healthcare providers and patients—is needed to achieve therapeutic goals in the management of type 2 diabetes. This educational activity will review interprofessional approaches that maximize patient engagement with the goal of achieving individual treatment goals. Clinical cases will be used to illustrate best practices for initiating insulin therapies, managing patients who exhibit psychological insulin resistance, improving adherence, and overcoming therapeutic inertia.