Insulin Analogs or Premixed Insulin Analogs in Combination With Oral Agents for Treatment of Type 2 Diabetes

Philip Levy, MD, FACE

Disclosures

April 16, 2007

Overcoming Practical Barriers to Insulin Therapy

There are a number of practical barriers that must be overcome to effectively initiate insulin therapy in patients with type 2 diabetes and improve poor adherence that may occur when patients are transitioned to this treatment.[75,76,77] The negative impact of regimen complexity on adherence to therapy in patients transitioning from oral to insulin therapy can be overcome by using any of the relatively simple treatment strategies described previously. Fear of needles can be overcome by reassuring patients that needles used today are much finer and that they are laser sharpened and silicone coated for ease of entry into the skin.[76] Furthermore, insulin pens can improve patient acceptance by enhancing dosing accuracy and permitting faster and easier dosing changes compared with a vial and syringe; insulin pens have also been reported to be more convenient and discreet.[76] A recent study comparing an insulin pen with vial and syringe use indicated that pens are more accurate and acceptable to patients, and require less training assistance.[78] Although few comparative studies of pens have been conducted, 1 recent study of the FlexPen (Novo Nordisk) and OptiClik (sanofi-aventis) pen devices suggested that FlexPen was easier to use, easier to learn how to use, preferred by more patients, and less prone to dosing errors.[79] These data are preliminary, however, and should be considered as such.

Fear of complications can be managed by appropriate patient education that emphasizes the benefits and lack of long-term complications associated with this treatment.[76] The risk for hypoglycemia with insulin therapy has been substantially reduced by the advent of newer insulin analogs,[80,81,82] and the risk for serious hypoglycemic episodes may also be reduced by making sure that the approach to insulin therapy fits with the patient's lifestyle (eg, exercise regimen, work schedule, and meal times), and by appropriate patient education.[76]

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