Effective Insulin Therapy
Richard M. Bergenstal,
Richard M. Bergenstal
International Diabetes Center, Park Nicollet Institute, Minneapolis, MN, USA
Search for more papers by this authorRichard M. Bergenstal,
Richard M. Bergenstal
International Diabetes Center, Park Nicollet Institute, Minneapolis, MN, USA
Search for more papers by this authorAbstract
Effective insulin therapy begins with an understanding of the clinically effective time actions of the insulin preparations available today. Rapid and long acting insulin analogues have been a great advance in the management of both type 1 and type 2 diabetes by improving glucose control and flexibility in schedules while minimizing hypoglycemia. Insulin is a key therapy often under-utilized in type 2 diabetes. The barriers to initiating insulin in type 2 diabetes must be understood and overcome. A systematic approach to insulin therapy, which emphasizes the importance of patient self-management and the use of team care, enhances the prospect of achieving optimal glucose control while maintaining a flexible and high-quality lifestyle for each individual with diabetes.
References
- 1 Home P. The challenge of poorly controlled diabetes mellitus. Diabetes Metab April 2003; 29: 101–9.
- 2 American Diabetes Association. Economic costs of diabetes in the U.S. in 2002. Diabetes Care 2003; 26: 917–32.
- 3 American Diabetes Association. Standards of medical care. Diabetes Care 2004; 27 (suppl 1): S15–35.
- 4Etzwiler DD. Chronic care: a need in search of a system. Diabetes Educ 1997; 23: 569–73.
- 5 Bodenheimer T, Lorig K, Holman H,Grumbach K. Patient self-management of chronic disease in primary care. JAMA 2002; 288: 2469–75.
- 6 Mazze RS, Etzwiler DD, Strock E, Peterson K, McClave CR, Meszaros JF, Leigh C, Owens LW, Deep LC, Peterson A, et al. Staged diabetes management: toward an integrated model of diabetes care. Diabetes Care 1994; 17 (suppl 1): 56–66.
- 7 Norris Sl, Engelgau MM, Narayan KM. Effectiveness of self-management in type 2 diabetes:systematic review of randomized controlled trials. Diabetes Care 2001; 24: 561–87
- 8 Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM, Jack L, Isham G, Snyder SR, Carande-Kulis VG, Garfield S, Briss P, McCullough D. The effectiveness of disease and case management for people with diabetes: a systematic review. Am J Prev Med 2002; 22 (4, suppl): 15–38.
- 9 Davidson J, Reader D,Rickheim P. Blood Glucose Patterns: A Guide to Achieving Targets. Minneapolis, MN: International Diabetes Center, Park Nicollet Institute, 2003.
- 10 Bergenstal R, Callahan T, Johnson M, Upham P, Hollander P, Spencer M, Castle G, Nelson J, Roth L, Etzwiler D. Management principles that most influence glycemic control: a follow-up study of former DCCT participants. Diabetes 1996; 45 (suppl 1): 124A.
- 11 Brewer KW, Chase HP,Owen S, Garg SK. Slicing the pie. Correlating HbA-values with average blood glucose values in a pie chart form. Diabetes Care 1998; 21 (2): 209–12.
- 12 Gaede P, Vedel P, Larsen N,Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348 (5): 383–93.
- 13 Grant RW,Cagliero E, Murphy-Sheehy P, Singer DE, Nathan DM, Meigs JB.Comparison of hyperglycemia, hypertension, and hypercholesterolemia management in patients with type 2 diabetes. Am J Med 2002; 112 (8): 603–9.
- 14 Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS 23). BMJ 1998; 316: 823–8.
- 15 The CDC Diabetes Cost-Effectiveness Group. Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA 2002; 287: 2542–51.
- 16 Saaddine JB, Engelgau MM, Beckles GL, Gregg EW,Thompson TJ, Venkat Narayan KM. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med 2002; 136: 565–74.
- 17 UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatement wand risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53.
- 18 DeWitt DE, Dugdale DC. Using new insulin strategies in the outpatient treatment of diabetes: clinical applications. JAMA 2003; 289 (17): 2265–9.
- 19 DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review. JAMA 2003; 289 (17): 2254–64.
- 20 Greaves CJ, Brown P, Terry RT, Eiser C, Lings P, Stead JW.Converting to insulin in primary care: an exploration of the needs of practice nurses. J Adv Nurs 2003; 42 (5): 487–96.
- 21 Kazlauskaite R, Fogelfeld L. Insulin therapy in type 2 diabetes [review]. Dis Mon June 2003; 49 (6): 377–420.
- 22 McDonald K. Insulin therapy today. Focusing on the basal–bolus balance. Adv Nurse Pract 2003; 11 (7): 40–4.
- 23 Royle P, Waugh N, McAuley L, McIntyre L, Thomas S.Inhaled insulin in diabetes mellitus [review]. Cochrane Database Syst Rev 2003; (3): CD003890.
- 24 Dills DG. New aspects of insulin therapy in type 1 and type 2 diabetes. Curr Diab Rep 2001; 1 (2): 112–8.
- 25 Sasali A,Leahy JL.Insulin therapy for type 2 diabetes. Curr Diab Rep 2003; 3 (5): 378–85.
- 26 Chan JL, Abrahamson MJ. Pharmacological management of type 2 diabetes mellitus: rationale for rational use of insulin [review]. Mayo Clin Proc 2003; 78 (4): 459–67.
- 27 Bergenstal RM. Optimization of insulin therapy in patients with type 2 diabetes. Endocr Pract 2000; 6: 93–7.
- 28 Weingarten SR, Henning JM, Badamgarav E, Knight K,Hasselblad K, Gano A Jr, Offman JJ. Interventions used in disease management programs for patients with chronic illness—which ones work? Meta-analysis of published reports. BMJ 2002; 325: 925–32.
- 29 Steinberg EP. Improving the quality of care—can we practice what we preach? N Engl J Med 2003; 348: 2681.
- 30 Leatherman S, Berwick D, Iles D, et al. The business case for quality: case studies and an analysis. Health Aff(Millwood) 2003; 22 (2): 17–30.
- 31 Bethel MA, Feinglos MN. Insulin analogues: new therapies for type 2 diabetes mellitus [review]. Curr Diab Rep 2002; 2 (5): 403–8.
- 32 Lepore M, Pampanelli S, Fanelli C, Porcellati F, Bartocci L, DiVincenzo A, Cordoni C, Costa E, Brunetti P, Bolli G. Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes 2000; 49: 2142–8.
- 33 Cefalu WT. Concept, strategies, and feasibility of noninvasive insulin delivery. Diabetes Care 2004; 27: 239– 46.
- 34 Heinemann L. Alternative delivery routes: inhaled insulin [review]. Diabetes Nutr Metab 2002; 15 (6): 417–22.
- 35
Cefalu WT,
Skyler JS,
Kourides IA,
Landschulz WH,
Balagtas CC,
Cheng SL,
Gelfan RA,
Inhaled Insulin Study Group. Inhaled human insulin treatment in patients with type 2 diabetes mellitus.
Ann Intern Med
2001;
3:
203–7.
10.7326/0003-4819-134-3-200102060-00011 Google Scholar
- 36 Nathan DM. Inhaled insulin for type 2 diabetes: solution or distraction [editorial]. Ann Intern Med 2001; 134: 242–4.
- 37 Bergenstal RM, for the Exubera Phase III Study Group. Efficacy and safety of inhaled insulin (Exubera®) compared with rosiglitazone in type 2 diabetes patients not optimally controlled on diet and exercise: results of a 3-month, randomised, comparative trial. Diabetologia 2003; 46 (suppl 2): A801.
- 38 Richter B, Neises G. Human insulin versus animal insulin in people with diabetes mellitus [review]. Cochrane Database Syst Rev 2003; (3): CD003816.
- 39 Jovanovic L, Ilic S, Pettitt DJ, Hugo K, Gutierriez M, Bowsher RR, Bastyr EJ. The metabolic and immunologic effects of insulin lispro. Diabetes Care 1999; 22: 1422–7.
- 40 The Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N EnglJ Med 2000; 342: 381–9.
- 41 The Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications Research Group. Effect of intensive therapy on microvascular complications of type 1 diabetes. JAMA 2002; 287: 2563–9.
- 42 The Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications Research Group. Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. N Engl J Med 2003; 348: 2294–303.
- 43 The Diabetes Control and Complications Trial/ Epidemiology of Diabetes Intervention and Complications Research Group. Sustained effect of intensive treatment of type 1 diabetes on development and progression of diabetic nephropathy. JAMA 2003; 290: 2159–67.
- 44 Berry LL, Seiders K, Wilder SS. Innovations in access to care: a patient-centered approach. Ann Intern Med 2003; 139: 568–74.
- 45 Heisler M, Vijan S, Anderson RM, Ubel P, Bernstein SJ, Hofer TP. Diabetes management improves when patients, doctors agree on treatment goals. J Gen Intern Med 2003.
- 46 Davidson PC, Hebblewhite HR, Bode BW, Richardson PL, Steed RD, Welch NS, Poulos E, Ybanez P. An empirical basis for modifying the “1500 rule.” Diabetes 2002; 51 (suppl 2): A518.
- 47 Prospective Diabetes Study (UKPDS) Group. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–12.
- 48 Article available at: https://www.accordtrial.org. Accessed December 10, 2003.
- 49 Wagner EH, Grothhaus LC, Sandhu N, Galvin MS, McGregor M, Artz K, Coleman EA. Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care 2001; 25: 695–700.
- 50 Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes: scientific review. JAMA 2002; 287 (3): 360–72.
- 51 Ahmann AJ, Riddle MC. Current oral agents for type 2 diabetes. Many options, but which to choose when? Postgrad Med May 2002; 111 (5): 32–4, 37–40, 43–6.
- 52 Korytkowski M. When oral agents fail: practical barriers to starting insulin. Int J Obes Relat Metab Disord 2002; 26 (suppl 3): S18–24.
- 53 Buse J. Combining insulin and oral agents. Am J Med 2000; 108 (suppl 6): 23S–32S.
- 54 Garber AJ. Benefits of combination therapy of insulin and oral hypoglycemic agents. Arch Intern Med 2003; 163 (15): 1781–2.
- 55 Bergenstal R, Johnson M, Whipple D, Noller D, Boyce K, Roth L, Upham P, DeBold R. Advantages of adding metformin to multiple dose insulin therapy in type 2 diabetes. Diabetes 1998; 47 (suppl 1): A347.
- 56 Yki-Järvinen H, Kauppila M, Kujansuu E, Lahti J, Marjanen T, Niskanen L, Rajala S, Ryysy L, Salo S, Seppala P, et al. Comparison of insulin regimens in patients with non-insulin-dependent diabetes mellitus. New Engl J Med 1992; 327: 1426–33.
- 57 Yki-Järvinen H, Ryysy L, Nikkilä K, Tulokas T, Vanamo R, Keikkilä M. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus: a randomized controlled trial. Ann Inter Med 1999; 130: 389–96.
- 58 Avilés-Santa L, Sinding J, Raskin P. Effects of metformin in patients with poorly controlled, insulin-treated type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 1999; 131: 182–8.
- 59 Riddle M. Combining sulfonylureas and other oral agents. Am J Med 2000; 108 (suppl 6a): 15S–22S.
- 60 Pugh JA, Wagner ML, Sawyer J, Ramirez G, Tuley M, Friesderg S. Is combination sulfonylurea and insulin therapy useful in NIDDM patients? Diabetes Care 1992; 15: 953–8.
- 61 Riddle MC, Schneider J. Beginning insulin treatment of obese patients with evening 70/30 insulin plus glimepiride versus insulin alone. Diabetes Care 1998; 21: 1053–7.
- 62 Riddle MC, Rosenstock J, Gerich J. The Treat-to-Target Trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care 2003; 26: 3080–6.
- 63 Trence DL. Management of patients on chronic glucocorticoid therapy: an endocrine perspective. Prim Care 2003; 30 (3): 593–605.
- 64 Hoogwerf B, Danese RD. Drug selection and the management of corticosteroid-related diabetes mellitus [review]. Rheum Dis Clin North Am 1999; 25 (3): 489–505.
- 65 Jovanovic L, Pettitt D. Gestational diabetes mellitus. JAMA 2001; 286: 2516–8.
- 66 Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 1998; 21 (suppl 2): B161–7.
- 67 Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343: 1134–8.
- 68 Trence DL, Kelly JL, Hirsch IB. The rationale and management of hyperglycemia for in-patients with cardiovascular disease: time for change [review]. J Clin Endocrinol Metab 2003; 88 (6): 2430–7.
- 69 van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345 (19): 1359–67.
- 70 Mesotten D, Van den Berghe G. Clinical potential of insulin therapy in critically ill patients [review]. Drugs 2003; 63 (7): 625–36.
- 71 Buse J. Combining insulin and oral agents. Am J Med. 2000; 108 (suppl 6): 23S–32S.
- 72 Bergenstal R, Fish L, List S. The insulin sliding scale is not dead. Arch Intern Med 1998; 158: 298.
- 73 Fish LH, Weaver TW, Moore AL, Steel LG. Value of postoperative blood glucose in predicting complications and length of stay after coronary artery bypass grafting. Am J Cardiol 2003; 92 (1): 74–6.
- 74 Bain SC, Gill GV, Dyer PH, Jones AF, Murphy M, Jones KE, Smyth C, Barnett AH. Characteristics of type 1 diabetes of over 50 years duration (the Golden Years Cohort). Diabet Med 2003; 20 (10): 808–11.
- 75 Goddard L, Wong K, Bashan A, Doria A, King G. Complication-free subjects after more than 50 years of type 1 diabetes mellitus. Diabetes 2003; 52 (suppl 1): A796.
- 76 Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC. Effect of improved glycemic control on health care costs and utilization. JAMA 2001; 285: 182–9.
- 77 Hayward RH, Manning WG, Kaplan SH, Wagner EH, Greenfield S. Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications, and resource utilization. JAMA 1997; 278: 1663–9.
- 78 Colwell JA. Controlling type 2 diabetes: are the benefits worth the costs? JAMA 1997; 278: 1700.
