Rising cost of insulin: A deterrent to compliance in patients with diabetes mellitus

Comparing dual oral agents plus insulin vs. Triple oral agents in uncontrolled type II diabetes: A pilot study

INTRODUCTION

Type II Diabetes mellitus (T2DM) patients often do not achieve glycemic control with oral hypoglycemic agents (OHAs). There are two main approaches to address this challenge: transitioning to a triple OHA regimen, or adding Insulin to the existing dual OHA regimen.

AIM

This study aimed to compare the efficacy of adding Insulin to dual OHAs (Sitagliptin + Metformin) against adding a third OHA to Sitagliptin + Metformin in achieving glycemic control among patients with uncontrolled T2DM.

METHOD

A pre-post study was conducted between 21 September 2023 and 21 December 2023 at Services Hospital Peshawar, Pakistan. Patients with uncontrolled T2DM with >7% HbA1c were divided into group 1 (Sitagliptin + Metformin plus a third OHA), and group 2 (Sitagliptin + Metformin plus pre-mixed Insulin 70/30). Glycemic control based on HbA1c values, fasting and random blood sugar levels, lipid profile, and body weight were evaluated after 3 months of therapy. The pre- and post- effect was compared by using a paired t-test.

RESULTS

The study included n = 80 patients with T2DM. Between groups 1 and 2, no significant difference was found in HbA1c values (9.1 vs. 9, with p = 0.724). However, BMI, cholesterol, and LDL significantly decreased in group 1 compared to group 2 (p<0.001 vs. p = 0.131, p = 0.023 vs. p = 0.896, and p = 0.003 vs. p = 0.395, respectively). Additionally, the incidence of hypoglycemic episodes was significantly lower in group 1 (7.5%) than in group 2 (47.5%, p = 0.004). No significant difference was observed between the triple OHA and dual OHA plus Insulin regimens in achieving glycemic control.

CONCLUSION

The triple OHA regimen improved BMI, cholesterol, and LDL levels, and reduced hypoglycemic episodes more effectively than dual OHA plus Insulin, despite similar HbA1c outcomes, suggesting it may be preferable for uncontrolled T2DM.

Challenges in Insulin Therapy: Perspectives of Malaysian Diabetes Educators

Background

Individuals with type 2 Diabetes Mellitus (T2DM) commonly need insulin therapy as their condition advances. Healthcare providers often face difficulties in managing patients who require insulin treatment. Gaining insight into the views of healthcare professionals on the obstacles encountered by patients using insulin can aid in improving care and developing effective treatment plans.

Objective

This study explores the views of Malaysian diabetes educators on the barriers faced by patients in using insulin.

Methods

Semi-structured qualitative interviews were conducted with diabetes educators (n=8) from the northern, central, and southern regions of Malaysia who were involved in diabetes care. We used an interview guide to facilitate the in-depth interviews, which were digitally recorded, transcribed verbatim, and analyzed using a thematic approach.

Results

Five themes were identified: the occurrence of side effects, the need for better patient education, negative perceptions towards insulin, the financial burden, and the complexity of adherence to treatment. There is a lack of patient education on proper glucose monitoring and how to optimize insulin therapy. The cost of treatment and patient ignorance are highlighted when discussing patient self-monitoring of blood glucose. Diabetes educators recognize that the absence of an effective follow-up mechanism is a major issue, particularly for those patients who fail to maintain consistent appointment schedules.

Conclusion

This research highlights five significant obstacles to maximizing the effectiveness of insulin therapy. Diabetes educators who identify and address these challenges can empower patients to manage their condition effectively. To overcome systemic barriers, government involvement is needed in creating insulin follow-up initiatives, establishing multidisciplinary teams for diabetes care, empowering education strategies, and providing financial support for self-monitoring.