Insulin Initiation During a 20-Minute Office Visit: Part 2: Making It Happen

Abstract

In type 2 diabetes, patient self-management plays an important role in the effective management of the disease. American Diabetes Association (ADA) guidelines recognize that diabetes self-management education is a key component of diabetes care and that care has shifted to place patients with diabetes at the center of the care model.1 It is therefore helpful for health care professionals to adopt a collaborative approach that empowers patients to become actively involved in their care and to play a role in selecting and using their medications, as well as adopting lifestyle and behavioral changes. Although lifestyle intervention is the initial approach in newly diagnosed type 2 diabetes, it is likely that insulin therapy will ultimately be required to achieve A1C targets. Effective self-management requires patients to understand and use various technologies, medications, and treatment strategies and be able to develop problem-solving skills.2 Achieving the optimal level of collaboration and patient understanding within the context of a typical 20-minute office visit poses a major challenge to health care providers, especially when discussing the initiation of insulin therapy. This article outlines key issues and offers strategies health care professionals can adopt for the initiation and intensification of insulin therapy in the setting of a standard office visit. It is now accepted that maintaining A1C levels as close as possible to the normal range (< 6.0%) helps to reduce the incidence of long-term microvascular complications such as nephropathy, neuropathy, and retinopathy in patients with type 2 diabetes.1,3–6 However, the benefits with respect to macrovascular complications have yet to be clearly established. Findings from two recent large-scale studies—the Action to Control Cardiovascular Risk in Diabetes (ACCORD) and the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trials—showed that intensive glycemic control did …