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Goldman JD, Angueira-Serrano E, Gonzalez JS, Pang C, Tait J, Edelman S. Survey Reveals Patient and Health Care Provider Experiences and Challenges With the Use of High Doses of Basal Insulin. Clin Diabetes 2022; 41:244-257. [PMID: 37092159 PMCID: PMC10115766 DOI: 10.2337/cd22-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes is a chronic, progressive disease, and its management results in a high emotional burden on patients. Eventually many patients require and can benefit from the use of insulin. This article reports results of a survey of patients and health care providers regarding their experiences of and challenges with the use of basal insulin. Health care providers can play a key role in helping people with type 2 diabetes overcome the challenges associated with the use of basal insulin, including connecting with their emotional needs and understanding the stressors associated with managing diabetes.
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Affiliation(s)
- Jennifer D. Goldman
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA
- Well Life Medical, Peabody, MA
| | | | | | | | | | - Steven Edelman
- University of California, San Diego, Veterans Affairs Medical Center, San Diego, CA
- Taking Control of Your Diabetes, La Jolla, CA
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2
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Prasathkumar M, Becky R, Anisha S, Dhrisya C, Sadhasivam S. Evaluation of hypoglycemic therapeutics and nutritional supplementation for type 2 diabetes mellitus management: An insight on molecular approaches. Biotechnol Lett 2022; 44:203-238. [PMID: 35119572 DOI: 10.1007/s10529-022-03232-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This review aims to summarize the current management of type 2 diabetes principles, including oral hypoglycemic agents, types of insulin administration, diet maintenance, and various molecular approaches. METHODS A literature search was conducted in different databases such as Scopus, ScienceDirect, Google Scholar, and Web of Science by using the following keywords: type-2 diabetes mellitus (T2DM), first-line and second-line treatment, oral hypoglycemic agents, insulin administration, diet/nutritional therapy, gene and stem cell therapy, and diabetic complications. RESULTS The first-line treatment of T2DM includes administering oral hypoglycemic agents (OHAs) and second-line treatment by insulin therapy and some OHAs like Sulfonylurea's (SU). The oral hypoglycemic or oral antidiabetic drugs have the function of lowering glucose in the blood. Insulin therapy is recommended for people with A1C levels > 7.0, and insulin administration is evolved drastically from the syringe, pump, pen, inhalation, insulin jet, and patch. The use of OHAs and insulin therapy during glycemic control has a severe effect on weight gain and other side effects. Hence, diet maintenance (macro and micronutrients) and nutritional therapy guidelines were also reviewed/recommended for safe T2DM management. Besides, the recent progress in molecular approaches that focuses on identifying new targets for T2DM (i.e.) consisting of gene therapy, stem cell therapy, and the modulation of insulin signaling pathways for the regulation of glucose storage and uptake also discussed. CONCLUSION The analysis of all these key factors is necessary to develop a potential agent to cure T2DM and suggest that a combination of therapies will pave the way for advanced management of T2DM.
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Affiliation(s)
- Murugan Prasathkumar
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India
| | - Robert Becky
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India
| | - Salim Anisha
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India
| | - Chenthamara Dhrisya
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India
| | - Subramaniam Sadhasivam
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India.
- Department of Extension and Career Guidance, Bharathiar University, Coimbatore, 641046, India.
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Chen J, Williams P, Perez-Nieves M, Piras De Oliveira C, Spaepen E, Osumili B, Poon JL, Schloot NC, Thun B, Blüher M. Satisfaction, Preference and Injection Habits of Switching to 200 Units/ml Insulin Lispro Pen from 100 Units/ml: A Patient Survey in Germany. Diabetes Ther 2021; 12:2939-2953. [PMID: 34542865 PMCID: PMC8519973 DOI: 10.1007/s13300-021-01150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The study was designed to assess patient satisfaction, preferences and injection habits for patients using insulin lispro 200 units/ml pen (IL200) compared to their previously used disposable 100 units/ml mealtime insulin pen ("MTI-100 pen") in Germany. METHODS A site-based, cross-sectional study involving a self-reported survey and medical record extraction in patients with diabetes currently using IL200 for between 3 and 12 months and had previously used any disposable MTI-100 pen. RESULTS Of 114 patients included, 83.3% were satisfied with IL200 and 3.5% were dissatisfied; 70.2% preferred IL200 over their previous MTI-100 pen and 4.4% preferred their previous MTI-100 pen. The main reasons for IL200 preference were the amount of insulin the pen carries, longer use before discarding, number of non-empty pens discarded, injection volume and frequency replacing pens. Patients discarded (median) 4 IL200 pens per month with 5.3% discarding more than 10 units in their last pen. When insufficient insulin remained to complete a dose, 74.6% injected the remainder and completed with a new pen, 19.3% discarded the pen with remaining insulin, 7.0% saved it for future use and 1.8% left the dose incomplete. CONCLUSIONS Satisfaction and preference for IL200 was high in this sample of patients using IL200 for 3-12 months. Reasons were consistent with IL200 features, explaining the better patient experience and potential resource saving transitioning from a disposable MTI-100 pen.
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Affiliation(s)
- Jieling Chen
- Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Paul Williams
- IQVIA, Real-World Solutions, 17 bis place des Reflets, Tour D2, TSA 64567, 92099, La Defense Cedex, France.
| | | | | | - Erik Spaepen
- HaaPACS GmbH, Bahnhofstraße 19C, 69198, Schriesheim, Germany
| | - Beatrice Osumili
- Eli Lilly and Company Limited, 8 Arlington Square West, Downshire Way, Bracknell, RG12 1PU, UK
| | | | - Nanette C Schloot
- Lilly Deutschland GmbH, Werner-Reimers-Str. 2, 61352, Bad Homburg vor der Höhe, Germany
| | - Barbara Thun
- IQVIA Commercial GmbH & Co. OHG, Real-World Solutions, Landshuter Allee 10, 80637, München, Germany
| | - Matthias Blüher
- Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Najmi U, Haque WZ, Ansari U, Yemane E, Alexander LA, Lee C, Demidowich AP, Motevalli M, Mackay P, Tucker C, Notobartolo C, Sartippour P, Raynor J, Zilbermint M. Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience. J Diabetes Sci Technol 2021; 15:741-747. [PMID: 33843291 PMCID: PMC8258519 DOI: 10.1177/19322968211002514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insulin pen injectors ("pens") are intended to facilitate a patient's self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. METHODS Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. RESULTS 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. CONCLUSIONS In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.
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Affiliation(s)
- Urooj Najmi
- American International School of Medicine, Atlanta, GA, USA
| | - Waqas Zia Haque
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Umair Ansari
- Pharmacy Department, Suburban Hospital, Bethesda, MD, USA
| | | | | | - Christina Lee
- Pharmacy Department, Suburban Hospital, Bethesda, MD, USA
| | - Andrew P. Demidowich
- Johns Hopkins Community Physicians at Howard County General Hospital, Columbia, MD, USA
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahsa Motevalli
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
| | - Periwinkle Mackay
- Department of Nursing Education, Suburban Hospital, Bethesda, MD, USA
| | - Cynthia Tucker
- Department of Nursing Education, Suburban Hospital, Bethesda, MD, USA
| | - Cindy Notobartolo
- Department of Safety, Security and Employee Health Services, Suburban Hospital, Bethesda, MD, USA
| | - Poroshat Sartippour
- Department of Management Information System, Suburban Hospital, Bethesda, MD, USA
| | | | - Mihail Zilbermint
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
- Mihail Zilbermint, MD, Johns Hopkins Community Physicians at Suburban Hospital, 8600 Old Georgetown Road, Bethesda, MD 20814, USA. ; Twitter: @Zilbermint; LinkedIn: https://www.linkedin.com/in/mishazilbermint/
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Basu S, Shao H, Luo J, Lipska K, Suda KJ, Yudkin JS. Estimates of insulin needs and dispensation given wastage, alternative glycemic targets, and non-insulin therapies in US populations with type 2 diabetes mellitus: A microsimulation study. J Diabetes Complications 2021; 35:107839. [PMID: 33455873 DOI: 10.1016/j.jdiacomp.2020.107839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
AIMS Registries and health plans estimate insulin need for population health metrics. We sought to identify how such estimates affect population- and individual-level estimates of over- and under-treatment. METHODS We developed a microsimulation comparing estimated insulin need to dispensation using the National Health and Nutrition Examination Survey (NHANES, 2005-2016, N= 2832) and Medical Expenditure Panel Survey (MEPS, 2005-2016, N = 29,615). RESULTS From NHANES, ~21.6% of people with type 2 diabetes would require insulin to achieve a HbA1c target of 7% after maximum titration of two non-insulins (60.7 IU/person/day, or 84,629,833 vials of 1000 IU in the US). From MEPS, we observed 57.4 IU/person/day of insulin dispensed (81,585,842 vials). About 29% of people were dispensed at least two standard deviations less than their estimated need, and 22% at least two standard deviations more than estimated need. Population-level need estimates reduced 39.4% if liberalizing HbA1c targets to 8% for people ≥75 years old. CONCLUSIONS Estimated insulin needs of people with type 2 diabetes in the U.S. are consistent with their dispensed insulin at the population level, but are sensitive to HbA1c targets for older adults, and conceal under- and over-treated subpopulations.
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Affiliation(s)
- Sanjay Basu
- Center for Primary Care, Harvard Medical School, United States of America; Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, United States of America; Research and Population Health, Collective Health, United States of America; School of Public Health, Imperial College London, UK.
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, United States of America
| | - Jing Luo
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, United States of America
| | - Kasia Lipska
- Section of Endocrinology, Department of Internal Medicine, Yale University School of Medicine, United States of America
| | - Katie J Suda
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, United States of America; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health Care System, United States of America
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, UK
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Chen J, Perez-Nieves M, Piras De Oliveira C, Spaepen E, Osumili B, Poon JL, Schloot N, Lara N, Garcia Alvarez L, Roset M. An assessment of physician reasons for prescribing Insulin Lispro 200 units/ml in Germany. Postgrad Med 2020; 132:727-736. [PMID: 33108957 DOI: 10.1080/00325481.2020.1805968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To understand physicians' reasons for prescribing Insulin Lispro 200 units/ml (IL200) and their experience with IL200 treatment in Germany. METHODS The survey consisted of 28 questions on physician's profile, average IL200 patients' characteristics and rationales for prescribing IL200. Questions were rated on a scale of 0 ('not at all important'/'strongly disagree') to 4 ('absolutely important'/'strongly agree'). RESULTS The surveyed physicians had a mean (SD) experience of 18.1 (7.0) years managing diabetes, consulted an average of 226.8 patients with diabetes/month and prescribed IL200 to 56.1% of their patients on mealtime insulin (MTI). About 80.0% of IL200 patients had type 2 diabetes mellitus, were overweight/obese, and received >20 units/day of MTI. More than 70.0% of physicians rated patient's insulin dose, pattern of self-measured glucose levels, hemoglobin A1c (HbA1c) (clinical); adherence, hypoglycemia knowledge, motivation to improve lifestyle, desire to reduce injection volume and emotional struggle with controlling HbA1c (behavioral) as 'very important'/'absolutely important' factors when prescribing IL200. CONCLUSION Physicians considered IL200 a promising treatment option that reduces the injection burden for patients on MTI. Physicians adopted a patient-centered perspective by aligning IL200 prescribing decisions with each patient's medical needs and non-clinical preferences, with an aim to encourage treatment adherence through resorting to IL200's advantageous attributes.
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Affiliation(s)
- Jieling Chen
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company , Indianapolis, Indiana, USA
| | - Magaly Perez-Nieves
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company , Indianapolis, Indiana, USA
| | | | - Erik Spaepen
- Global Medical Affairs, HaaPACS GmbH , Schriesheim, Germany
| | - Beatrice Osumili
- Global Patient Outcomes and Real World Evidence, International, Eli Lilly and Company Ltd , Windesham, Surrey, UK
| | - Jiat-Ling Poon
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company , Indianapolis, Indiana, USA
| | - Nanette Schloot
- Medical Affairs, Lilly Deutschland GmbH , Bad Homburg Vor Der Höhe, Germany
| | - Nuria Lara
- Real World Evidence Solutions, IQVIA, Real-World Evidence Solutions , Barcelona, Spain
| | - Laura Garcia Alvarez
- Real World Evidence Solutions, IQVIA, Real-World Evidence Solutions , Barcelona, Spain
| | - Montserrat Roset
- Real World Evidence Solutions, IQVIA, Real-World Evidence Solutions , Barcelona, Spain
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Matza LS, Osumili B, Stewart KD, Perez-Nieves M, Jordan J, Biricolti G, Romoli E, Losi S, Del Santo S, Spaepen E, Parola G, Karn H, Boye KS. Patient Preferences and Health State Utilities Associated with Mealtime Insulin Concentrations Among Patients with Diabetes in Italy. Diabetes Ther 2020; 11:319-330. [PMID: 31760598 PMCID: PMC6965595 DOI: 10.1007/s13300-019-00718-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Standard concentration (100 units/mL) mealtime insulin is frequently used to treat patients with type 1 (T1D) and type 2 diabetes (T2D). A more concentrated version of the medication (200 units/mL) has been available in Italy since 2016. This concentrated version is bioequivalent to the standard version and delivers the same amount of medication but in half the volume of liquid. The purpose of this study was to examine patient preferences and estimate health state utilities associated with standard and concentrated rapid-acting mealtime analog insulin. METHODS Participants with T1D and T2D in Italy valued two health states in time trade-off interviews. The descriptions of diabetes and treatment in the two health states were identical, differing only in terms of insulin concentration (e.g., half as much liquid for the same dose, less effort needed to press the injection button, and fewer injection pens required with concentrated insulin). To ensure participants understood the health states, they were shown a short video illustrating the differences between concentrations. RESULTS A total of 217 participants completed the interviews (49.8% male; mean age 56.1 years; 109 from Milan; 108 from Rome; 12.0% T1D; 88.0% T2D). When asked which health state they preferred, 98.2% responded the concentrated version, 0.9% said the standard version, and 0.9% had no preference. Mean [standard deviation (SD)] utilities rounded to three decimals were 0.892 (0.099) for the concentrated version and 0.884 (0.101) for the standard version. The mean (SD; p value) utility difference between the standard and concentrated rapid-acting insulin was 0.007 (0.019; p < 0.0001). CONCLUSIONS Findings from this study provide insight into patient preferences associated with concentration of rapid-acting insulin. Although the difference in utility is small, patients consistently preferred the concentrated formulation over the standard insulin, and for some patients this difference had an impact on utility valuations. These results suggest that the concentration of rapid-acting insulin should be considered because it could affect treatment preference and quality of life. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | | | | | | | | | | | - Serena Losi
- Eli Lilly Italia S.p.A, Sesto Fiorentino, Italy
| | | | - Erik Spaepen
- Eli Lilly Deutschland GmbH, Bad Homburg, Germany
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Schloot NC, Hood RC, Corrigan SM, Panek RL, Heise T. Concentrated insulins in current clinical practice. Diabetes Res Clin Pract 2019; 148:93-101. [PMID: 30583034 DOI: 10.1016/j.diabres.2018.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 11/22/2022]
Abstract
New concentrated insulins (exceeding 100 units/mL) and dedicated devices have recently become available, offering new treatment options for people with diabetes, for basal and prandial insulin supplementation. The concentrated insulin formulations range from 2-fold concentration (insulin lispro 200 units/mL) with rapid-acting prandial action to 5-fold concentration (human regular insulin, 500 units/mL) with basal and short-acting prandial actions. Long-acting basal insulins include degludec 200 units/mL and glargine 300 units/mL. Concentrated insulins have been developed with the goal of easing insulin therapy by reducing the volume and number of injections and in some cases making use of altered pharmacokinetic and pharmacodynamic properties. This review summarizes the unique characteristics of each concentrated insulin to help healthcare providers and people with diabetes understand how to best use them.
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Affiliation(s)
- Nanette C Schloot
- Lilly Deutschland GmbH, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany.
| | - Robert C Hood
- Endocrine Clinic of Southeast Texas, 3030 North Street, Suite 560, Beaumont, TX, USA
| | | | - Robert L Panek
- Syneos Health, 3201 Beechleaf Court, Raleigh, NC 27604, USA.
| | - Tim Heise
- Profil, Hellersbergstraße 9, 41460 Neuss, Germany.
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Hood RC. Why Do Some Concentrated Insulins Maintain Their Pharmacokinetics/Pharmacodynamics Profile? Diabetes Technol Ther 2017; 19:203-205. [PMID: 28418731 DOI: 10.1089/dia.2017.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
MESH Headings
- Diabetes Mellitus/blood
- Diabetes Mellitus/drug therapy
- Drug Administration Schedule
- Drug Compounding
- Excipients/chemistry
- Humans
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/blood
- Hypoglycemic Agents/pharmacokinetics
- Hypoglycemic Agents/therapeutic use
- Injections, Subcutaneous
- Insulin Glargine/administration & dosage
- Insulin Glargine/blood
- Insulin Glargine/pharmacokinetics
- Insulin Glargine/therapeutic use
- Insulin Lispro/administration & dosage
- Insulin Lispro/blood
- Insulin Lispro/pharmacokinetics
- Insulin Lispro/therapeutic use
- Insulin, Long-Acting/administration & dosage
- Insulin, Long-Acting/blood
- Insulin, Long-Acting/pharmacokinetics
- Insulin, Long-Acting/therapeutic use
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/blood
- Insulin, Regular, Human/pharmacokinetics
- Insulin, Regular, Human/therapeutic use
- Osmolar Concentration
- Recombinant Proteins/administration & dosage
- Recombinant Proteins/blood
- Recombinant Proteins/pharmacokinetics
- Recombinant Proteins/therapeutic use
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