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Dalal MR, Grabner M, Bonine N, Stephenson JJ, DiGenio A, Bieszk N. Are patients on basal insulin attaining glycemic targets? Characteristics and goal achievement of patients with type 2 diabetes mellitus treated with basal insulin and physician-perceived barriers to achieving glycemic targets. Diabetes Res Clin Pract 2016; 121:17-26. [PMID: 27616634 DOI: 10.1016/j.diabres.2016.08.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
AIMS To investigate treatment patterns and achievement of glycemic targets in patients with type 2 diabetes mellitus treated with basal insulin in a real-world setting, and to determine physicians' beliefs and practices regarding these patients. METHODS This study had two components; a retrospective analysis using a US claims database of patient and treatment data, and a survey of physicians' beliefs and practices. RESULTS A total of 39,074 patients treated with basal insulin were included in this analysis. The proportion of patients achieving HbA1c<7.0% (53mmol/mol) was similar in ongoing basal insulin users at baseline (26%) and at 3months follow-up (27%). The number of new initiators achieving HbA1c<7.0% (53mmol/mol) increased from baseline (11%) to 3months (27%). In the physician survey component, the majority of physicians indicated they would continue to increase basal insulin dose as long as was needed to reach HbA1c/fasting blood glucose goals (85% of physicians treating 'not on-goal' patients, 78% of physicians treating 'on-goal' patients). Physician-perceived barriers to insulin intensification included patient's lifestyle, non-adherence, and concerns about out-of-pocket costs. CONCLUSIONS A large proportion of patients on insulin-based therapy fail to reach glycemic goals. More education of clinicians may improve insulin intensification rates and increase the proportion of patients reaching glycemic targets.
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Affiliation(s)
- Mehul R Dalal
- Millennium Pharmaceuticals, a wholly-owned subsidiary of Takeda Pharmaceuticals Inc., Cambridge, MA, USA.
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52
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Oster G, Sullivan SD, Dalal MR, Kazemi MR, Rojeski M, Wysham CH, Sung J, Johnstone B, Cali AMG, Wei LJ, Traylor L, Anhalt H, Hull M, Van Vleet J, Meneghini LF. Achieve control: a pragmatic clinical trial of insulin glargine 300 U/mL versus other basal insulins in insulin-naïve patients with type 2 diabetes. Postgrad Med 2016; 128:731-739. [PMID: 27690710 DOI: 10.1080/00325481.2016.1241663] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aims to compare the effectiveness of insulin glargine 300 U/mL (Gla-300) with its accompanying patient support program with that of other basal insulin and available patient support programs in patients with type 2 diabetes (T2D) in a real-world setting in terms of achieving HEDIS (Healthcare Effectiveness Data and Information Set) individualized glycemic targets without documented symptomatic hypoglycemia. METHODS Achieve Control is a US-based, multicenter, randomized, open-label, active-controlled, parallel group pragmatic Phase IV trial in insulin-naïve patients with T2D uncontrolled on ≥2 oral antidiabetes drugs (OAD) and/or glucagon-like peptide-1 receptor antagonists (GLP-1 RA). Inclusion criteria include a diagnosis of T2D, age ≥18 years, and glycated hemoglobin (HbA1c) between 8.0% and 11.0%. Patients will be assigned to either the Gla-300 or other basal insulin group. The primary end point is the proportion of patients achieving HEDIS HbA1c targets (<8.0% [64 mmol/mol] in patients with comorbidities or aged ≥65 years; <7.0% [58 mmol/mol] in all other patients) without occurrence of symptomatic hypoglycemia (blood glucose ≤70 mg/dL) from baseline to 6 months. Secondary end points include rates of documented symptomatic nocturnal hypoglycemia and severe hypoglycemia; change from baseline in HbA1c, fasting glucose, and body weight; treatment persistence; patient-reported outcomes; and healthcare resource utilization. Planned enrollment is 3270 patients across approximately 400 clinical sites. CONCLUSION Pragmatic clinical trials offer the potential to assess comparative effectiveness in broadly based patient populations receiving care (with or without a corresponding educational support program) in real-world clinical settings. The results of Achieve Control should elucidate the benefits of management of T2D with Gla-300 versus other basal insulins in terms of patient outcomes, experiences, and perceptions, and its impact on healthcare resource utilization and cost. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifier is NCT02451137.
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Affiliation(s)
- Gerry Oster
- a Policy Analysis Inc. , Brookline , MA , USA
| | | | - Mehul R Dalal
- c Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited. , Cambridge , MA , USA
| | | | | | | | | | | | | | - L J Wei
- h Harvard T.H. Chan, School of Public Health , Boston , MA , USA
| | | | | | | | | | - Luigi F Meneghini
- j University of Texas Southwestern Medical Center and Parkland Health & Hospital System , Dallas , TX , USA
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53
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Matsuba I, Sawa T, Kawata T, Kanamori A, Jiang D, Machimura H, Takeda H, Han JH, Wang K, Tanaka K, Shen L, Ajima M, Kaneshiro M, Kim SW, Umezawa S, Asakura T, Suzuki S, Kim SC. Cross-National Variation in Glycemic Control and Diabetes-Related Distress Among East Asian Patients Using Insulin: Results from the MOSAIc Study. Diabetes Ther 2016; 7:349-60. [PMID: 27255328 PMCID: PMC4900985 DOI: 10.1007/s13300-016-0178-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Guidelines recommend insulin progression for patients with type 2 diabetes (T2D) with inadequate glycemic control. The Multinational Observational Study Assessing Insulin use (MOSAIc [ClinicalTrials.gov identifier, NCT01400971]) study is a 2-year observational study, investigating factors that influence insulin progression in T2D patients. In this first of two reports, we describe baseline clinical and psychosocial characteristics of Chinese, Japanese, and South Korean patients who participated in MOSAIc. Insulin treatment, factors affecting progression, and outcomes will be reported separately. METHODS Patients with T2D using insulin for ≥3 months were eligible. Baseline demographic, clinical, and psychosocial data were collected from patients. Quality of life instruments, including the Diabetes Distress Scale (DDS), were used to assess patient's concerns about disease management, support, and emotional burden. The association between the DDS and the selected covariates was also assessed. RESULTS A total of 373 patients in China, 157 in Japan, and 141 in South Korea were enrolled from July 2011 to July 2013. Mean ± standard deviation duration (years) of T2D differed across countries (China 11.4 ± 7.5; Japan 13.8 ± 8.7; South Korea 15.7 ± 8.8; P < 0.0001). Japanese patients used more noninsulin anti-hyperglycemic agents than did Chinese or South Korean patients (P < 0.0001). Exclusive use of basal insulin was most common in Japan and South Korea compared with China, whereas approximately 66.8% of Chinese patients used mixed insulin. Covariates associated with the DDS were younger age [P = 0.044 (Japan)], higher incidence of monthly hypoglycemia [P = 0.036 [China]; P = 0.021 (South Korea)], and male gender [P = 0.037 (South Korea)]. CONCLUSIONS There were significant differences amongst East Asian patients with T2D treated with insulin, including in quality of life scores. Results from the MOSAIc longitudinal analyses will further investigate trends of insulin intensification and barriers to insulin progression. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Ikuro Matsuba
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
| | - Tasuku Sawa
- Department of Internal Medicine, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Takehiro Kawata
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Akira Kanamori
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | | | - Hideo Machimura
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hiroshi Takeda
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | | | - Ke Wang
- Eli Lilly Suzhou Pharmaceutical Company, Shanghai, China
| | - Keiji Tanaka
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Li Shen
- Eli Lilly Suzhou Pharmaceutical Company, Shanghai, China
| | - Miho Ajima
- Department of Diabetology, Kawasaki Saiwai Clinic, Kanagawa, Japan
| | - Mizuki Kaneshiro
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Sang-Wook Kim
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Shinichi Umezawa
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Taro Asakura
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | | | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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54
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Holmes-Truscott E, Skinner TC, Pouwer F, Speight J. Negative appraisals of insulin therapy are common among adults with Type 2 diabetes using insulin: Results from Diabetes MILES - Australia cross-sectional survey. Diabet Med 2015; 32:1297-303. [PMID: 25683652 DOI: 10.1111/dme.12729] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 02/03/2023]
Abstract
AIM To identify insulin therapy appraisals among adults with Type 2 diabetes using insulin and how negative appraisals relate to clinical, self-care and psychosocial outcomes. METHODS Diabetes MILES - Australia 2011 was a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 273 adults with Type 2 diabetes using insulin (46% women; mean ± sd age: 59 ± 9 years; diabetes duration: 12 ± 7 years; years using insulin: 4 ± 4). They completed validated measures of insulin therapy appraisals (ITAS), depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and diabetes-specific self-efficacy (DES-SF). RESULTS Insulin was perceived to be very important, and its benefits (e.g. improves health) were endorsed by most (82%). Fifty-one per cent believed that taking insulin means their diabetes has become worse; 51% that insulin causes weight gain; 39% that they have 'failed to manage' their diabetes. Those with the greatest and least 'ITAS negative' scores did not differ by diabetes duration or years using insulin, or by average number of insulin injections or blood glucose checks per day. Those with more negative insulin appraisals were significantly younger (Mean Diff. = 5 years, P < 0.001), less satisfied with recent blood glucose levels (P < 0.001, d = 0.63), had reduced diabetes-specific self-efficacy (P < 0.001, d = 0.7), and were more likely to report depressive symptoms, anxiety or diabetes distress (all P < 0.001, d = 0.65-1.1). CONCLUSIONS Negative insulin therapy appraisals are common among adults with Type 2 diabetes using insulin, and are associated with lower general and diabetes-specific emotional well-being, reduced diabetes-specific self-efficacy and satisfaction with blood glucose.
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Affiliation(s)
- E Holmes-Truscott
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia-Vic, Melbourne
- School of Psychology, Deakin University, Burwood
| | - T C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Australia
| | - F Pouwer
- CoRPS, Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - J Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia-Vic, Melbourne
- School of Psychology, Deakin University, Burwood
- AHP Research, Hornchurch, UK
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Goderis G, Van Casteren V, Declercq E, Bossuyt N, Van Den Broeke C, Vanthomme K, Moreels S, Nobels F, Mathieu C, Buntinx F. Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: A registry based cohort study. Prim Care Diabetes 2015; 9:354-361. [PMID: 25709079 DOI: 10.1016/j.pcd.2015.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/07/2015] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
AIMS To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT=insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT. METHODS Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression. RESULTS Comparing patients with (N=271) vs. without a CT (N=4424), we noted significant differences (p<0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98mg/dl), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p<0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p<0.05) after 2009 in the CT-group. CONCLUSIONS Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification.
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Affiliation(s)
- Geert Goderis
- Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Viviane Van Casteren
- Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium
| | - Etienne Declercq
- Faculty of Public Health, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Nathalie Bossuyt
- Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium
| | | | - Katrien Vanthomme
- Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium
| | - Sarah Moreels
- Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium
| | | | | | - Frank Buntinx
- Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium; Department of General Practice, Maastricht University, Maastricht, The Netherlands
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56
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Hirsch IB, Schneider D, King A, Polonsky WH, Reid TS, Shubrook J, Verderese CA, Wallace J, Riddle MC. A Short-Acting GLP-1 Analog or Prandial Insulin to Supplement Basal Insulin?—Moving Toward Personalized Management of Type 2 Diabetes Mellitus. Postgrad Med 2015; 126:135-44. [DOI: 10.3810/pgm.2014.05.2763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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57
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Silva DDR, Bosco AA. An educational program for insulin self-adjustment associated with structured self-monitoring of blood glucose significantly improves glycemic control in patients with type 2 diabetes mellitus after 12 weeks: a randomized, controlled pilot study. Diabetol Metab Syndr 2015; 7:2. [PMID: 25904987 PMCID: PMC4405992 DOI: 10.1186/1758-5996-7-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/09/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) has been recommended as a useful tool for improving glycemic control, but is still an underutilized strategy and most diabetic patients are not aware of the actions that must be taken in response to its results and do not adjust their treatment. The purpose of this study was to evaluate the effectiveness and safety of an educational program for insulin self-adjustment based on SMBG in poorly controlled patients with type 2 diabetes (T2DM). METHODS A prospective, randomized, controlled 12-week intervention study was conducted on poorly controlled insulin-requiring patients with T2DM. Twenty-three subjects were randomized to two educational programs: a 2-week basic program with guidance about SMBG and types and techniques of insulin administration (group A, n = 12) and a 6-week program including the basic one and additional instructions about self-titration of insulin doses according to a specific protocol (group B, n = 11). Patients were reviewed after 12 weeks and baseline to endpoint changes in glycated hemoglobin (A1C), insulin doses, body weight and incidence of hypoglycemia were compared by paired and independent Student t-tests. RESULTS After 12 weeks, there was a significant reduction in A1C only in group B, but group comparison showed no significant difference (p = 0.051). A higher percentage of subjects in group B achieved an A1C near the treatment target (<7.5%) than in group A. Daily insulin dose increased non-significantly in the two groups and there was no significant difference in the incidence of hypoglycemia or body weight changes between groups. CONCLUSIONS Training for self-titrating insulin doses combined with structured SMBG can safely improve glycemic control in poorly controlled insulin-treated T2DM patients. This strategy may facilitate effective insulin therapy in routine medical practice, compensating for any reluctance on the part of physicians to optimize insulin therapy and thus to improve the achievement of recommended targets of diabetes care.
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Affiliation(s)
- Daniel Dutra Romualdo Silva
- Postgraduate Program, Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, Belo Horizonte, MG Brazil
| | - Adriana Aparecida Bosco
- Postgraduate Program, Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, Belo Horizonte, MG Brazil
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58
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Abstract
Despite advances in treatment for type 2 diabetes in recent decades, many patients are failing to achieve adequate glycemic control. Poor glycemic control has been shown to have a detrimental effect on patients' health and well-being, and to have significant negative financial implications for both patients and healthcare systems. Insulin therapy has been proven to significantly reduce glycated hemoglobin levels; however, both patients and physicians can be reluctant to initiate insulin therapy. Research shows that both patient and provider factors contribute to a delay in initiation of insulin therapy. This review discusses the most common barriers contributing to this delay with potential solutions to overcome them.
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Affiliation(s)
- Steven Edelman
- Department of Endocrinology and Metabolism, VA San Diego Healthcare Center, San Diego, Calif.
| | - Jeremy Pettus
- Department of Endocrinology, University of California, San Diego, Calif
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59
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Helena WR, Karolicki B. Management of Type 2 Diabetes - Methods for Addition of Prandial to Basal Insulin. EUROPEAN ENDOCRINOLOGY 2014; 10:124-130. [PMID: 29872476 DOI: 10.17925/ee.2014.10.02.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/08/2014] [Indexed: 11/24/2022]
Abstract
As glycaemic control deteriorates with the progression of type 2 diabetes, treatment guidelines advocate starting basal insulin therapy, and then progressing to a basal-bolus regimen as needed. Nevertheless, although timely intensification of therapy is important to minimise the risk of diabetic complications, considerable clinical inertia exists, not only in the initiation of insulin but also in the progression to multiple-dose insulin regimens. One barrier has been the lack of guidance about how to make the transition from basal-only to basal-bolus insulin therapy. In this review, we discuss how data from the recent FullSTEP study, along with other randomised studies, will help to bridge this gap. Prandial boluses can be added to basal insulin in a stepwise manner, using a straightforward, patient-led dose titration approach and simple estimation of which meal to add the initial prandial bolus to. Reducing the complexity of progression to multiple-dose insulin regimens and empowering patients will lessen the burden on clinicians, improve treatment satisfaction and facilitate timely implementation of treatment guidelines.
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Affiliation(s)
- W Rodbard Helena
- Medical Director, Endocrine and Metabolic Consultants, Rockville, Maryland, US
| | - Boris Karolicki
- Medical Director, Novo Nordisk Inc., Princeton, New Jersey, US
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Polinski JM, Connolly JG, Curtis BH, Seeger JD, Gaskins K, Perez M, Smith BF, Shrank WH. Patterns and trends in insulin intensification among patients with type 2 diabetes: a systematic review. Prim Care Diabetes 2014; 8:101-109. [PMID: 24275103 DOI: 10.1016/j.pcd.2013.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 11/26/2022]
Abstract
Type 2 diabetes (T2DM) diagnoses are skyrocketing, making treatment of this disease an increasing focus of primary care visits. Guidelines recommend insulin intensification over time to achieve HbA1c targets. We conducted a systematic review regarding patterns and trends of insulin intensification and barriers to intensification. Providers across primary and specialty care settings often did not intensify insulin regimens despite patients' clinical status. Even among progressed patients, HbA1c values remained high. The paucity of available studies prevented a comprehensive understanding of patterns and trends in insulin intensification. Such information is needed to assess the quality of pharmacologic care for patients with T2DM.
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Affiliation(s)
- Jennifer M Polinski
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - John G Connolly
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States
| | | | - John D Seeger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | - Magaly Perez
- Eli Lilly and Company, Indianapolis, IN, United States
| | - Benjamin F Smith
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States
| | - William H Shrank
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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61
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Escalante M, Gagliardino JJ, Guzmán JR, Tschiedel B. Call-to-action: timely and appropriate treatment for people with type 2 diabetes in Latin America. Diabetes Res Clin Pract 2014; 104:343-52. [PMID: 24835577 DOI: 10.1016/j.diabres.2014.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/27/2013] [Accepted: 01/01/2014] [Indexed: 01/27/2023]
Abstract
Latin America faces a unique set of challenges in the treatment of type 2 diabetes mellitus (T2DM). This report identifies these challenges and provides a framework for implementation of the strategies, policies and education programs which are needed to optimize the management of this condition. In order to improve future diabetes care, it will be necessary to address existing problems such as limitation of resources, inadequate management of hyperglycemia, and inappropriate education of healthcare team members and people with diabetes. Achieving these goals will require collaborative efforts by many individuals, groups and organizations. These include policymakers, international organizations, healthcare providers, those responsible for setting medical school curricula, patients and society as a whole. It is anticipated that improved/continuing education of healthcare professionals, diabetes self-management education and development of a team approach for T2DM care will lead to optimization of patient-centered care. Implementation of multicentric demonstration studies and rational use of antidiabetic treatments will be necessary to demonstrate the long-term favorable impact of these strategies upon quality of care, prevention of chronic complications, mortality, healthcare costs and patient quality of life.
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Affiliation(s)
- Miguel Escalante
- Hospital de Especialidades, Centro Medico Nacional de Occidente, Mexican Institute of Social Security, Guadalajara, Mexico.
| | - Juan José Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata), PAHO/WHO Collaborating Centre for Diabetes, Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Juan Rosas Guzmán
- Centro de Especialidades Medicas de Celaya, Latin University of Mexico in Celaya, Guanajuato, Mexico
| | - Balduino Tschiedel
- Institute for Children with Diabetes in Porto Alegre and the Brazilian Diabetes Society, Porto Alegre, Brazil
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62
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Hirsch IB, Buse JB, Leahy J, McGill JB, Peters A, Rodbard HW, Rubin RR, Skyler JS, Verderese CA, Riddle MC. Options for prandial glucose management in type 2 diabetes patients using basal insulin: addition of a short-acting GLP-1 analogue versus progression to basal-bolus therapy. Diabetes Obes Metab 2014; 16:206-14. [PMID: 23711193 DOI: 10.1111/dom.12136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 05/07/2013] [Accepted: 05/19/2013] [Indexed: 12/27/2022]
Abstract
Integrating patient-centered diabetes care and algorithmic medicine poses particular challenges when optimized basal insulin fails to maintain glycaemic control in patients with type 2 diabetes. Multiple entwined physiological, psychosocial and systems barriers to insulin adherence are not easily studied and are not adequately considered in most treatment algorithms. Moreover, the limited number of alternatives to add-on prandial insulin therapy has hindered shared decision-making, a central feature of patient-centered care. This article considers how the addition of a glucagon-like peptide 1 (GLP-1) analogue to basal insulin may provide new opportunities at this stage of treatment, especially for patients concerned about weight gain and risk of hypoglycaemia. A flexible framework for patient-clinician discussions is presented to encourage development of decision-support tools applicable to both specialty and primary care practice.
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Affiliation(s)
- I B Hirsch
- Department of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA, USA
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63
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Fleming SE, Boyd A, Ballejos M, Kynast-Gales SA, Malemute CL, Armstrong Shultz J, Vandermause RK. Goal Setting With Type 2 Diabetes. DIABETES EDUCATOR 2013; 39:811-9. [DOI: 10.1177/0145721713504471] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to explicate and interpret common experiences of diabetes educators (DEs) with patient goal setting for patients with type 2 diabetes in diabetes education. Methods Transcripts (n = 10) from semi-structured interviews were analyzed using a hermeneutic phenomenological approach to more deeply explore the accounts of DEs’ goal setting with patients with type 2 diabetes. Results The overarching pattern that emerged was “Striking a Balance,” which subsumed 4 subthemes: Applying Theoretical-Practical Principles When Setting Goals, Identifying Idealistic-Realistic Expectations, Creating Patient-Educator–Centered Plans, and Readying-Living With Goal Setting. The pattern, “Striking a Balance,” revealed a common meaning of DEs as experiences requiring balance and nuance in goal setting with patients. Implications The results of this study combined with the tenets of the self-determination theory can provide the DEs with real-life exemplars and a theoretical framework to encourage their patients to self-manage, increase intrinsic motivation, and improve adherence related to their lifestyle changes and glycemic control. DEs, as facilitators of change, can implement these changes with flexible and reciprocal activities with their patients. The DEs owned these activities and they are: “building the bond,” “sharing the session,” “readying for change,” “sending them home,” and “bringing them back.”
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Affiliation(s)
- Susan E. Fleming
- Washington State University, Spokane, Washington (Dr Fleming, Ms Boyd, Dr Kynast-Gales, Dr Ballejos, Ms Malemute, Dr Armstrong Shultz, Dr Vandermause)
| | - Angela Boyd
- Washington State University, Spokane, Washington (Dr Fleming, Ms Boyd, Dr Kynast-Gales, Dr Ballejos, Ms Malemute, Dr Armstrong Shultz, Dr Vandermause)
| | - Miriam Ballejos
- Washington State University, Spokane, Washington (Dr Fleming, Ms Boyd, Dr Kynast-Gales, Dr Ballejos, Ms Malemute, Dr Armstrong Shultz, Dr Vandermause)
| | - Susan A. Kynast-Gales
- Washington State University, Spokane, Washington (Dr Fleming, Ms Boyd, Dr Kynast-Gales, Dr Ballejos, Ms Malemute, Dr Armstrong Shultz, Dr Vandermause)
| | - Charlene L. Malemute
- Washington State University, Spokane, Washington (Dr Fleming, Ms Boyd, Dr Kynast-Gales, Dr Ballejos, Ms Malemute, Dr Armstrong Shultz, Dr Vandermause)
| | - Jill Armstrong Shultz
- Washington State University, Spokane, Washington (Dr Fleming, Ms Boyd, Dr Kynast-Gales, Dr Ballejos, Ms Malemute, Dr Armstrong Shultz, Dr Vandermause)
| | - Roxanne K. Vandermause
- Washington State University, Spokane, Washington (Dr Fleming, Ms Boyd, Dr Kynast-Gales, Dr Ballejos, Ms Malemute, Dr Armstrong Shultz, Dr Vandermause)
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