Letter from the Editor, #683: Insulin as Needed

A colleague, the director of pharmacy for a large multi-office ACO in our area, called me recently. One of his Clinical MTM pharmacists had heard from some patients who were using Lantus or Levemir as needed. He contacted me to find out if I had ever seen this before. This got me thinking about starting type 2 patients on insulin at diagnosis. I contacted a couple of doctors who were early prescribers of insulin to ask what they thought of using Lantus or Levemir as needed.

Both the Treat to Target and 303 protocols from Sanofi and Novo respectively, are based on patients titrating their long acting insulin based on fasting glucose levels. Although we typically would have a patient on a Lantus or Levemir dose and titrate up, these physicians are using good glucose as a reason not to inject insulin at all. These patients are usually on multiple oral medications and their need for insulin is due to their lack of interest in making lifestyle changes. They have received training on proper habits and if they follow these habits then no insulin is needed; however if they don’t, then insulin is needed. This new method may prove to be valuable in the future as a new study presented at the recent ADA Scientific Sessions indicates that newly diagnosed patients are less likely to stay on their medications. 

If you are concerned about improving your Medicare 5 Star ratings then you will probably want to download this week’s Tool for Your Practice: Comprehensive Diabetic Foot Exam (CDFE) Form and ADA CDFE Pocket Chart. This tool makes it easier to do a foot exam which gives a measurable percentage in maximizing reimbursement rates. 

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Dave Joffe, Editor-in-chief