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Overcoming the Hurdles of Insulin Initiation

This Physician’s Weekly feature covering insulin initiation and strategies to overcome hurdles was completed in cooperation with the experts at the American Diabetes Association. According to current recommendations for the management of type 2 diabetes, timely initiation of both oral medications alone or in combination with insulin therapy is paramount to ensuring a desired level of glycemic control and improved patient outcomes. Although most providers agree that insulin is an effective approach to treating diabetes, many still consider it a last resort. “Patients are hesitant to take insulin for a variety of reasons,” says Mary T. Korytkowski, MD. “It is important that providers understand some of the barriers that exist among patients for insulin initiation as a way of reducing some of the negative attitudes many express to this form of therapy as a way of ensuring good outcomes.” Before initiating insulin, it can be helpful to obtain an understanding of a patient’s view of insulin therapy. “When patients express apprehension, efforts to identify the reasons underlying this apprehension or refusal to take insulin can provide clinicians with the information they need to improve acceptance,” Dr. Korytkowski says. “Insulin therapy means different things to different people. When barriers exist, it is important to determine the level of concern among patients and ask open-ended questions [Figure 1]. Responses to such questions allow for the ability to follow up with additional inquiries that can help guide physicians to better understand and support their patients’ concerns.” Assessing Patient Barriers Several common patient related barriers to insulin initiation have been identified. These include: Beliefs that insulin is a personal failure. Beliefs that insulin...
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