Insulin therapy and patient adherence
We help patients with diabetes increased cooperation on drug use. Initiating and Optimizing Insulin Therapy: Patient Adherence. Traditionally, our approach to blood glucose management has been the periodic re-evaluation of antiglycemic therapy, with intensification of treatment when glycemic control was deemed inadequate. Unfortunately, substantial evidence in "real-world" situations points to a certain "clinical inertia" in responding appropriately with treatment adjustments. Physicians may lack the time, resources, or skills to effectively convince and teach patients how to initiate insulin therapy. Patients, on the other hand, may perceive the need for insulin therapy as loss of control and disease worsening, as well as personal failure, and they may be anxious about injections.
These barriers need to be actively identified and resolved if we are to successfully optimize glycemic control and reduce disease-related complications in patients with worsening beta-cell function. Glycemic monitoring, through A1c testing and daily self-monitoring of blood glucose, provides useful information in determining not only the timing of insulin initiation, but also the most appropriate insulin type and distribution. For example, patients with fasting hyperglycemia and A1c levels under 9% may respond well to basal insulin replacement, whereas a patient with predominantly postprandial glucose elevations or A1c values above 9% may do better with twice-daily premixed insulin. Insulin therapy may also be used as initial therapy at diagnosis of diabetes patient(type 2) to rapidly correct hyperglycemia and reverse glucotoxicity, with re-evaluation of treatment options after stabilization of the metabolic status. Insulin has many advantages, it is highly effective in reducing blood sugar levels and reduce the workload on the pancreas down. Patient education is essential to the successful implementation of medical treatment, particularly with regard to insulin replacement therapy.
Patients need to understand that, despite their best efforts to control diabetes through lifestyle modification and medication adherence, beta-cell function wanes over time and insulin replacement is an expected and effective intervention to correct hyperglycemia and prevent "disease" progression, specifically end-organ damage from chronic hyperglycemia.
