Hurdles to Insulin Adoption
Despite the benefits of early insulin therapy in treatment, adoption has thus far been minimal, due to three main hurdles:
1. Patient resistance: The need for injection drives the great majority of patients toward noninvasive oral therapy. Despite modifications like smaller needle sizes, insulin has yet to become desirable for patients, specifically the growing diabetic pediatric population.
2. Risk of inducing hypoglycemia from an insulin overdose: While a serious potential side effect, this risk is arguably less influential on the adoption of early insulin therapy. Fortunately, in the earlier stages of the disease, when glucose responses are still functional, hypoglycemia is less of a concern and can usually be countered with the consumption of a rapidly absorbed carbohydrate.
3. Patient outlook and the negative stigma associated with insulin use: Patients view insulin therapy as permanent and many believe that insulin therapy is addictive, thus making treatment cessation difficult. Numerous studies have shown that not only can insulin therapy be stopped, but in newly diagnosed T2DM patients, near-normal glucose levels could be maintained via only diet and exercise after intensive insulin therapy.
Another common complaint is that insulin encourages weight gain. Although it has certainly been shown to stimulate the appetite, the supplementation of insulin therapy with a healthy diet and regular exercise can help reduce the risk for weight gain.
All of these treatment hurdles stem from an overall lack of patient education. Indeed, insulin treatment continues to improve through the emergence of novel insulin analogs including slow-acting basal insulins, long-acting insulins for postprandial use, and premixes of the two types. Additionally, certain categories of insulins, primarily the basal insulin analogs, may have a very promising future in the early management of T2DM, particularly in emerging economies as they can offer a more cost-effective form of treatment through the delay, or possible prevention, of therapy via multiple OADs.