Wednesday , January 24 2018

From the Editor

January, 2018

  • 23 January

    Jan. 23, 2018

    Over the past couple of weeks in our main newsletter, Steve has introduced you to the idea of using software that includes considerations for insurance coverage and cost to pinpoint diabetes care. However, we all know that patients with diabetes have multiple disease states and we need to maximize therapy …

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January, 2018

Test Your Knowledge

Insulin Therapy Barriers

A 51-year-old patient returns to your office for a follow-up visit. She is currently taking metformin and glipizide after being diagnosed with type 2 diabetes 8 years ago. She shows you her self-care logs that indicate she has been eating a healthy diet and walking daily. She has been maintaining her weight (BMI 26kg/m2). Despite her excellent efforts, her A1C is 7.8%, above her target of A1C<7.0%. When you start to discuss adding a basal insulin dose to her regimen, she bursts into tears. All of the following are common barriers to insulin therapy initiations EXCEPT:

Correct

Correct Answer:  A. Fear that hyperglycemia will make her ill

Educational Critique: Common patient-identified barriers to initiating insulin therapy are: fear others will see them differently; insulin is not an effective treatment for diabetes; using insulin can lead to complications or death; concern that using insulin will negatively impact their lifestyle; fear of hypoglycemia: fear of weight gain; fear of needles of injection pain; and insulin cost concerns. Fear of hypoglycemia can be ameliorated with choosing insulin less likely to cause hypoglycemia (newer rapid-acting and longer-acting analogue insulins) as well as patient education on the frequency, avoidance, recognition and treatment of hypoglycemia.

Sources:

Patient. 2014; 7(4): 437–450.  Published online 2014 Jun 24. doi:  10.1007/s40271-014-0068-x

Diabetes Care. 2010 Apr; 33(4): 733–735.  Published online 2010 Jan 19. doi:  10.2337/dc09-1184

Incorrect

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January, 2018