We have known for many years that many people with type 2 diabetes (T2D) and high blood glucose levels would benefit from insulin, but this is often delayed. We also know that, once started, using daily insulin to manage diabetes is challenging. Avoidance of insulin in T2D is due to several factors including concerns about side effects like weight gain and very low blood sugar (hypoglycemia) as well as fear that self-management with insulin is too burdensome. People with diabetes may view the need for insulin as a personal failure and think that their quality of life will worsen if insulin is started. Other important considerations include the cost of insulin, health beliefs based on culture and previous experience, and provider bias that the person with diabetes may not be able to safely start or increase their insulin. This includes bias based on race and ethnicity and other social determinants of health.

Diabetes technologies in the toolbox

In a recent review, researchers from Sansum Diabetes Research Institute (SDRI), in collaboration with colleagues from the US and Europe, examine technology to support use of insulin in T2D. They found that new digital health tools can help by tracking time and dose of each insulin injection, providing dose advice based on glucose and dose data, sending reminders, and supporting diabetes education. Tools include smart insulin pens that capture the dose and timing of an insulin injection. Smartphone applications (apps) integrate several management functions into one tool with connected devices such as blood glucose meters for use by both patients and professionals. Technology should include a reminder function letting users know when they need to take insulin and when they have forgotten their dose. Telehealth, in which a doctor monitors a patient’s health remotely, might also help some people using insulin. Patient concerns about lack of contact with their caregiver should be considered when developing new technology, and options for users to engage more with professionals should be allowed.

Overcoming clinical inertia

New digital health tools may reduce barriers to optimal insulin therapy.

Source: https://bit.ly/3LJ2w8G

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