Barriers to Advancing Treatment With Insulin Therapy for Type 2 Diabetes Mellitus Patients

A significant challenge facing primary care physicians (PCPs) in the treatment of their patients with type 2 diabetes mellitus (T2DM) is overcoming patient and clinical barriers that prevent advancing treatment with insulin therapy. As discussed in Dr. Leahy’s introduction to this Website, barriers presented by patients often involve “needle phobia,” a sense of “failing oral therapy,” and the patient’s mistaken association between insulin use and comorbidities that result from vascular damage during diabetes. The reluctance to begin insulin therapy for T2DM patients may be due to a physician’s concerns about insulin-induced weight gain, hypoglycemia, or being able to effectively address patients’ perceptions of insulin therapy. Each practice may need to develop its own particular scheme or responses to overcome its specific barriers. This Website has been developed to provide an interactive forum for PCPs to identify and share “best practices” implemented for advancing treatment of patients with T2DM to achieve their glycemic goals. Please share with us barriers you encounter when trying to advance treatment for T2DM patient therapy and your “best practice” for overcoming them. If you have questions or observations that you believe might be of interest, please share them as well!

Comments

Saad Sakkal.MD said:

How to Improve Patients Adherence to DM treatment Guidelines?

Saad Sakal, MD, FACE    Anthony Michael Albisser, PhD    

Objective: Patients adherence to therapy is a major challenge.Improving adherenc will improve diabetic control .How do we help adherence

Discussion: it is by now well established that the DCCT/EDIC has proven the value good glycemic control for intermed. and long term outcome.But keeping most patient adhering to a therapy is still a major challenge,mostly in the range of 53-65% for oralRx, 60% for diet,19%for exercise,daily BGSM in39% of patients on insulin, and just5% on oral agent/diet/exer. in general TypeI has better adher. a recent article journal in "clin- ical Diabetes" described factors effecting adherence,and as result control,complications and life. Humalink software system has been also proven byond a doubt its effi-cacy,validity,cost effectivness,and safety in a number of studies now in more than 8oo patients.We tested in this study effect on adherence, for near a year.We were very happy to see adherence rate in excellent range(90%) whish is rare in any chronic disease.This adherence led to a better glycemic control aswell as full metabolic control as seen in FBS,PPGluc,HgA1c,Fructosamine, Triglyc.,Cholesterol.And excellent drp in Hypog/Hyerglycemic episodes ,while maintainig stable weight at lower insulin dose. The reason is the collaboration therapy mode whish only Humalink has today.

Conclusions: Humalink offers a 90% adherence rate,with instant feedback,better than any other system or protocol exists today ,at a greater savings,less resources(one MD,RN,clerck),better value index,safety, and cost effectivness.This is a result of its advanced collaboration mode whish makes the patient an active participant in care enjoiying the shared interaction twice weekly whish is within the range most patients will tolerate(40-50%) as most adherence studies shows. Humalink is best well proven system

# January 29, 2008 11:08 PM

Carlos Campos MD said:

Excellent info, Dr. Sakal.  The Humalink software is a option we should consider.  I wonder for those of us who have EHR, how this would be incorporated.

Any thoughts, Dr. Nuckols?

# February 11, 2008 6:48 PM

Saad Sakkal MD said:

It is so easy to incorporate the new version of Humalink into any EMR(it is called Rx checker) .it is available on a flash disk with an easy instant upload through any USB slot for desk top ,laptop or any PC.

If you are interested please E mail me  

# February 12, 2008 10:30 PM

steve chen said:

what do you think about the ACCORD trial?

# February 13, 2008 8:58 AM

Carlos Campos MD said:

It appears that tactics to get the A1c below 6.0% were very aggressive; ie. using SU's and prandin combos and etc.

This is one reason ADA recommends only <7%.

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