Technology to overcome clinical inertia in insulin therapy

Abstract

The evidence that lowering of blood glucose concentrations in diabetes can reduce risk of complications is well established; however, many people with type 2 diabetes do not reach recommended glycaemic targets. 1 Selvin E Parrinello CM Daya N Bergenstal RM Trends in insulin use and diabetes control in the U.S.: 1988–1994 and 1999–2012. Diabetes Care. 2016; 39: e33-e35 Crossref PubMed Scopus (72) Google Scholar Type 2 diabetes is typically a progressive disease with stepwise increases in blood glucose-lowering therapy needed to achieve and maintain glucose targets. Data from many health-care systems show that delays occur in intensifying therapies in those who do not to reach glycaemic targets. 2 Khunti K Millar-Jones D Clinical inertia to insulin initiation and intensification in the UK: a focused literature review. Prim Care Diabetes. 2017; 11: 3-12 Summary Full Text Full Text PDF PubMed Scopus (132) Google Scholar , 3 Harris S Yale JF Dempsey E Gerstein H Can family physicians help patients initiate basal insulin therapy successfully?: randomized trial of patient-titrated insulin glargine compared with standard oral therapy: lessons for family practice from the Canadian INSIGHT trial. Can Fam Physician. 2008; 54: 550-558 PubMed Google Scholar As a consequence, many people with diabetes spend years with poor glycaemic control. Automated insulin dosing guidance to optimise insulin management in patients with type 2 diabetes: a multicentre, randomised controlled trialThe combination of automated insulin titration guidance with support from health-care professionals offers superior glycaemic control compared with support from health-care professionals alone. Such a solution facilitated safe and effective insulin titration in a large group of patients with type 2 diabetes, and now needs to be evaluated across large health-care systems to confirm these findings and study cost-effectiveness. Full-Text PDF