Pharmacists Improve Insulin Initiation in Diabetics

Despite the advent of a multitude of non-insulin therapies, insulin maintains its place in diabetes management.

Almost all patients with type 2 diabetes derive benefit from insulin therapy, and the American Diabetes Association strongly recommends that patients with A1C values of 10% or greater switch to insulin.

However, many patients are reluctant or unable to start insulin therapy.

The American Journal of Therapeutics published a study on insulin adherence conducted by a team of researchers who recently presented their findings at the American College of Clinical Pharmacy Global Conference.

The study authors enrolled 120 patients with A1C values at 10% or higher into this retrospective, observational, cohort study. Patients with type 1 diabetes, those already receiving insulin, and those with few A1C readings were excluded.

Enrolled patients had a mean A1C of 11.7%, and more than 30% of them were on at least 2 antidiabetic agents.

The researchers found that the availability of novel oral antidiabetics (dipeptidylpeptidase-4 inhibitors and sodium glucose-linked transporter-2 inhibitors) combined with a lower risk of hypoglycemia and more convenient administration might delay insulin initiation. These therapies are unlikely to help patients with an A1C level greater than 10% achieve a goal A1C of less than 7%.

Another barrier is lack of time or resources for patient and provider education and monitoring.

However, patients were more likely to initiate insulin and achieve their A1C goal quicker if they met with a pharmacist. Those who met with a pharmacist had a 90% chance of initiating insulin, making pharmacists powerful advocates for the practice.

Previous studies have shown that pharmacists can also improve adherence to guideline-recommended use of aspirin, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and statins in the ambulatory setting.

The exclusion of most enrolled patients due to insulin therapy history and lack of follow-up limits the current study’s external validity. These patients are generally less adherent to therapy and less likely to their achieve A1C goals.

The study authors called for future research into these excluded populations.