Pharmacists underutilised in insulin therapy

Pictured: Professor Stephen Twigg, Associate Professor Margaret McGill, Professor Ian Spence

Many people with diabetes aren’t receiving the best treatment for their condition due to barriers to putting them on insulin therapy, three diabetes experts say.

And the fear of dying in bed is a real concern for people with diabetes, as they battle with nocturnal hypoglycaemia resulting in poor sleep, which affects mood and wellbeing.

Three diabetes healthcare experts spoke at a Sanofi event today in Sydney on the reality of non-adherence to diabetes treatments, barriers to insulin therapy and the complexity of the disease, which has resulted in what they call “treatment inertia” in healthcare professionals and patients alike.

Diabetes educator Associate Professor Margaret McGill, head of endocrinology, Royal Prince Alfred Hospital, Professor Stephen Twigg, and pharmacologist Professor Ian Spence spoke about how healthcare professionals and patients think it’s “all too hard” to consider insulin therapy, commonly indicated in type 2 diabetes, due to barriers such as:

  • apathy despite oral anti-diabetic drug failure;
  • concern regarding the ability of the patient to undertake treatment;
  • fear or losing or alienating the patient;
  • concerns regarding hypoglycaemia and weight gain; and
  • inadequate time or personnel to teach administration of therapy.

“Around 366,000 people living with diabetes currently require insulin therapy,” says Prof Twigg.

“This represents 32% of all people with diabetes. Approximately 52 new people require insulin therapy every day.

“Hypoglycaemic episodes at night are more common than hyperglycaemic ones, and should be considered as a complication of diabetes that severely affects quality of life,” he says.

The experts advised that overcoming these barriers means that healthcare professionals should never use insulin therapy as a threat.

They should understand that the fear of injecting is common, but needle phobia is rare, they say.

“It’s how you sell it that is key to acceptance. A blood test is more painful than the injection. Don’t teach technique first—just stick it in and then teach,” says Prof McGill.

She says that pharmacists are an underutilised resource in keeping people on insulin therapy as people spend less than 12 hours with a healthcare professional for their condition—the rest of the time it’s self-managed.

“Pharmacists can use creative proactive methods and emphasise the importance of taking insulin regularly and at the same time,” she says.

“Advice should be given that they need to cut down on calories to prevent weight gain as a 1% reduction of HbA1c can lead to 1–2kg weight gain on insulin therapy.

“Help eliminate social stigma, especially in some ethnic communities, by saying that a patient can start their insulin in the morning or at bedtime, until they gain confidence to use it at another time as needed,” says Prof McGill.

Pharmacists can also improve medication adherence by actively involving people in treatment decisions, she says.

Examples of conversation starters could include: “How often do you miss your medication?” not “Do you ever miss taking your medication?” “Are you changing sites when injecting?” “Any lumps or bumps troubling you?”

The experts also said that with 280 people being diagnosed with the condition each day, the economic impact of diabetes and its complications are also high, with projections that the cost of treating the disease in Australia will increase from $1.6bn in 2003 to $8.6bn in 2033.

Pictured: Professor Stephen Twigg, Associate Professor Margaret McGill, Professor Ian Spence

by Jayamala Gupte

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