Medication adherence and the associated health-economic impact among patients with type 2 diabetes mellitus converting to insulin pen therapy: An analysis of third-party managed care claims data

Results: We included 68 randomized controlled trials in the analysis of rapid-acting insulin analogues and 49 in the analysis of long-acting insulin analogues. Most of the studies were of short to medium duration and of low quality. In terms of hemoglobin A1c, we found minimal differences between rapid-acting insulin analogues and regular human insulin in adults with type 1 diabetes (weighted mean difference for insulin lispro: ‐0.09%, 95% confidence interval [CI] ‐0.16% to ‐0.02%; for insulin aspart: ‐0.13%, 95% CI ‐0.20% to ‐0.07%). We observed similar outcomes among patients with type 2 diabetes (weighted mean difference for insulin lispro: ‐0.03%, 95% CI ‐0.12% to ‐0.06%; for insulin aspart: ‐0.09%, 95% CI ‐0.21% to 0.04%). Differences between long-acting insulin analogues and neutral protamine Hagedorn insulin in terms of hemoglobin A1c were marginal among adults with type 1 diabetes (weighted mean difference for insulin glargine: ‐0.11%, 95% CI ‐0.21% to ‐0.02%; for insulin detemir: ‐0.06%, 95% CI ‐0.13% to 0.02%) and among adults with type 2 diabetes (weighted mean difference for insulin glargine: ‐0.05%, 95% CI ‐0.13% to 0.04%; for insulin detemir: 0.13%, 95% CI 0.03% to 0.22%). Benefits in terms of reduced hypoglycemia were inconsistent. There were insufficient data to determine whether insulin analogues are better than conventional insulins in reducing longterm diabetes-related complications or death. Interpretation: Rapid- and long-acting insulin analogues offer little benefit relative to conventional insulins in terms

/pdf/efficacy-and-safety-of-insulin-analogues-for-the-management-3y828l0qr0.pdf

Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis

Purpose
To define and understand patient psychological insulin resistance (PIR) and its impact on diabetes management.

/pdf/psychological-insulin-resistance-patient-beliefs-and-c8gdfmo0ns.pdf

Psychological insulin resistance: patient beliefs and implications for diabetes management

T ype 2 diabetes is a progressive disease characterized by relentless deterioration of pancreatic β-cell function.1 With the increasing incidence of type 2 diabetes, especially among younger individuals who will live longer with their disease, more patients will develop severe insulin deficiency and require insulin replacement. Because primary care providers see the vast majority of patients with type 2 diabetes, they may soon find themselves overwhelmed with insulin-requiring patients.

This article provides some practical guidelines for initiating insulin therapy in primary care practice. It is important to remember, however, that these are general guidelines and that management should be individualized for each patient.

Some primary care providers may be apprehensive about using insulin in patients with type 2 diabetes. Wallace and Matthews2 have gone so far as to suggest that patients and providers have often “colluded in implicit and unspoken contracts to continue oral agents for as long as possible.”

Concerns about hypoglycemia and patient willingness and/or ability to inject insulin are good reasons why many providers may approach insulin therapy with caution. Compounding this reluctance is the perception that insulin therapy is too complex to manage in a busy primary care practice; prescribing information provided by manufacturers has been somewhat vague regarding initial dosing and titration. Because of these factors, providers may delay in making the necessary transition from oral agents to insulin. Indeed, recent evidence suggests that the hemoglobin A1c (A1C) result that triggers glucose-lowering action is ≥ 9%.3 This is unfortunate because numerous studies have shown that excellent glycemic control can be achieved with insulin therapy in patients with type 2 diabetes.4-7 Moreover, there is an increasing body of evidence showing that early and effective intervention with insulin is more important than had been previously believed.8-10

### Early and Aggressive Intervention Matters

Insulin …

https://clinical.diabetesjournals.org/content/diaclin/23/2/78.full.pdf

A Real-World Approach to Insulin Therapy in Primary Care Practice

Hypoglycemic activity and oral bioavailability of insulin-loaded liposomes containing bile salts in rats: the effect of cholate type, particle size and administered dose.

FlexPen: addressing issues of confidence and convenience in insulin delivery.

Randomized, multinational, open-label, 2-period, crossover comparison of biphasic insulin aspart 30 and biphasic insulin lispro 25 and pen devices in adult patients with type 2 diabetes mellitus

Leo Niskanen

Papers

FlexPen: addressing issues of confidence and convenience in insulin delivery.

Randomized, multinational, open-label, 2-period, crossover comparison of biphasic insulin aspart 30 and biphasic insulin lispro 25 and pen devices in adult patients with type 2 diabetes mellitus