Initiating, Intensifying, and De-intensifying Insulin Webinar

Summary

Dr. Bob Gabe leads a webinar on overcoming therapeutic inertia in diabetes management, focusing on insulin initiation, intensification, and de-intensification. Experts from various healthcare settings discuss strategies to improve patient outcomes, address barriers to insulin therapy, and highlight the importance of a team-based approach in diabetes care.

Takeaways

• 🌟 The American Diabetes Association (ADA) is leading an initiative called 'overcoming therapeutic inertia,' which is supported by Sanofi Diabetes. This initiative aims to address the delay or inaction in initiating, intensifying, or de-intensifying therapy for diabetes when glycemic goals are not met.
• 🏥 Therapeutic inertia can have negative consequences for people with diabetes, increasing their risk of complications and impacting healthcare costs. The ADA provides resources on their website to help healthcare professionals overcome this inertia.
• 💉 Initiating insulin therapy can be challenging due to factors like fear of needles, lack of understanding, and poor adherence to treatment plans. Healthcare professionals need to provide guidance and support to help patients manage these challenges.
• 👩‍⚕️ The role of a diabetes educator is crucial in reducing therapeutic inertia. They can provide in-depth assessments, address knowledge gaps, and help patients understand the progressive nature of type 2 diabetes and the importance of insulin therapy.
• 📈 A1C levels are a critical indicator of diabetes management. Increases in A1C levels, like the case of Annette with an A1C of 11.4%, signal the need for more intensive therapy and highlight the importance of regular monitoring and adjustments to treatment plans.
• 🍽️ Diet and lifestyle play a significant role in diabetes management. Educators and healthcare professionals must work with patients to understand their dietary habits and barriers to adherence, helping to tailor treatment plans that fit their lifestyles.
• 💊 Medication adherence is a key factor in managing diabetes. Patients like Richard, who experienced homelessness and lost access to his medication, highlight the need for support systems to ensure patients can maintain their treatment plans.
• 📉 The progressive nature of type 2 diabetes means that treatment plans often need to be adjusted over time. Healthcare professionals must be vigilant in monitoring patients' A1C levels and other health markers to determine when adjustments are necessary.
• 💼 The cost of diabetes treatment, including insulin and other medications, can be a significant barrier for patients. Healthcare professionals should be aware of patient assistance programs and affordable options to help patients access the care they need.
• 🤝 A team-based approach to diabetes management, involving dietitians, pharmacists, and other healthcare professionals, is essential for overcoming therapeutic inertia and improving patient outcomes. Each member of the team brings unique insights and support to the patient's treatment plan.

Q & A

What is therapeutic inertia?

Therapeutic inertia refers to the delay or inaction in initiating, intensifying, or de-intensifying therapy when glycemic goals are not met. This can lead to negative consequences for people with diabetes, such as increased risk of complications.

Why is overcoming therapeutic inertia important in diabetes management?

Overcoming therapeutic inertia is crucial because it can help improve glycemic control, reduce the risk of diabetes-related complications, and lower the overall cost of care for society.

What role do healthcare professionals play in addressing therapeutic inertia?

Healthcare professionals play a key role in identifying and overcoming therapeutic inertia by providing guidance on initiating insulin therapy, intensifying treatment, and de-intensifying insulin therapy when appropriate.

What are some of the challenges faced by patients when starting insulin therapy?

Challenges include fear of needles, lack of understanding of how to use insulin, and barriers such as limited literacy or numeracy skills, which can affect their ability to manage their diabetes effectively.

How can diabetes educators contribute to reducing therapeutic inertia?

Diabetes educators can contribute by providing thorough assessments, addressing knowledge gaps, and offering practical demonstrations and education on insulin use, treatment of hypoglycemia, and the progressive nature of type 2 diabetes.

What is the significance of the case study involving Annette, a 66-year-old woman with type 2 diabetes?

Annette's case illustrates the common challenges patients face when starting insulin therapy, such as lack of understanding and fear of needles. It highlights the importance of diabetes education in overcoming these barriers.

Why is it important to monitor postprandial glucose levels in addition to fasting glucose levels?

Monitoring postprandial glucose levels is important because it provides a more comprehensive view of a patient's glycemic control throughout the day. High postprandial glucose levels can indicate the need for additional therapy to manage post-meal blood sugar spikes.

What is the role of a clinical pharmacist in a federally qualified health center like El Rio Health in Tucson, Arizona?

Clinical pharmacists in federally qualified health centers play a direct provider role, working within collaborative practice agreements to manage patient care, including diabetes treatment, medication adjustments, and addressing social determinants of health.

How can the cost of insulin and other diabetes medications impact therapeutic inertia?

The high cost of insulin and other diabetes medications can lead to medication non-adherence, which contributes to therapeutic inertia. Patients may ration their medications or skip doses due to cost, leading to poor glycemic control and increased risk of complications.

What strategies can be used to address the issue of insulin-induced weight gain in patients with type 2 diabetes?

Strategies include optimizing insulin dosing, leveraging therapies that can assist with weight management such as GLP-1 receptor agonists, SGLT2 inhibitors, and considering the use of older insulin formulations that may have a lower risk of weight gain.

How can healthcare teams work together to improve diabetes management in patients with complex needs?

Healthcare teams can improve diabetes management by leveraging a team-based approach, including physicians, nurses, dietitians, pharmacists, and social workers. This approach allows for comprehensive care that addresses medical, nutritional, social, and psychological needs.