Diabetes patients struggle with insulin adherence, dose adjustment
MedWire News: An international survey of diabetes patients and their physicians shows that a high level of insulin omission and lack of dose adjustment during the course of therapy are common.
Although more patients believed insulin had a positive rather than negative impact on their lives, they found treatment restrictive and controlling.
"Physicians should consider prescribing more flexible insulin regimens and reducing the burden of the treatment regimen," say Mark Peyrot (Loyola University of Maryland, Baltimore, USA) and colleagues in Diabetic Medicine.
In patients with diabetes, delays in insulin initiation and consequent exposure to prolonged periods of poor glycemic control are believed to increase the severity and progression of macrovascular, as well as microvascular, complications.
Effective insulin therapy includes four critical accomplishments: initiation, adherence, persistence, and intensification.
"Unfortunately, there are failures at each juncture, some of which can be attributed to patients, some to providers and all, in part, because of the nature of the insulins and delivery systems that are available to patients and physicians," Peyrot et al note.
In the current study, the researchers performed an internet survey of 1250 physicians (600 specialists, 650 primary care physicians) treating diabetes and a telephone survey of 1530 insulin-treated patients (180 with Type 1 diabetes, 1350 with Type 2 diabetes) in China, France, Japan, Germany, Spain, Turkey, the UK, and the USA.
One third (33.2%) of patients reported insulin omission or nonadherence on at least 1 day in the past month, with an average of 3.3 days of omission per month.
Most physicians reported that many insulin-treated patients do not have adequate glucose control (87.6%) and that they would treat more aggressively if not for concern about hypoglycemia (75.5%).
Physicians reported low patient success at initiating insulin in a timely fashion and adjusting insulin doses.
Patients and providers indicated the same five most common reasons for insulin omission or nonadherence: too busy; travelling; skipped meals; stress/emotional problems; public embarrassment.
"Research is needed to better understand physician concern about hypoglycemia, especially as it affects their choices of diabetes management goals and strategies," say Peyrot et al, adding that this "could help to identify measures to improve patient and physician diabetes management and outcomes."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Andrew Czyzewski