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PCPs Lack Consensus on Insulin Therapy

Primary care physicians (PCPs) disagree more than they agree when it comes to insulin therapy in type 2 diabetes, suggests a cross-sectional Web survey of 505 PCPs. They're at odds about the inevitability of insulin initiation, whether patients track blood glucose enough, and whether insulin training takes too much time, reveal findings presented by Clarice (Risa) P. Hayes, PhD, at the American Diabetes Association's 67th Scientific Sessions, held June 22–26 in Chicago.

PCPs did agree on some aspects of insulin, as delivered subcutaneously; the PCPs were surveyed before pulmonary insulin (Exubera, Pfizer) hit the market. More than 75% of the PCPs said insulin's benefits outweigh the risks, but its delivery by injection can be a barrier and patients on oral therapy tend to fear it.

PCPs also agreed that education helps patients overcome insulin fears and adhere to treatment.

But PCPs differed on other aspects of insulin therapy. Roughly half of them strongly agreed with the statements below, while half strongly disagreed:

• Patients on insulin monitor blood glucose with sufficient frequency.
  
• Hypoglycemia risk makes me reluctant to prescribe insulin for patients >85 years of age.
  
• Patients will eventually need to go on insulin even if adherent to a diabetes regimen.
  
• Patients will not need to go on insulin if they follow physicians' recommendations.
  
• Training in insulin use is too time-consuming for medical staff.
  

To a lesser degree, PCPs were split on whether insulin therapy increases insulin resistance and whether higher insulin levels in obese patients can cause more insulin resistance.

Survey respondents were PCPs with >3 years' experience who see >10 type 2 diabetes patients a week. Half were internists, and half were family doctors or general practitioners. More than a quarter of the respondents frequently saw patients >85 years of age and with a body mass index >35.

To Hayes, who conducted the survey with James T. Fitzgerald, PhD, PCPs' lack of consensus indicates a need for increased continuing medical education (CME) on treatment and physiology related to insulin.

"CME programs need to provide PCPs with strategies and tools for the initiation of insulin therapy, particularly PCPs with challenging diabetes populations," says Hayes, senior health outcomes research scientist with Eli Lilly and Company.

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Law, B. M. Search for Related Content PubMed Articles by Law, B. M. Social Bookmarking                What's this?