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Published in: Diabetes Therapy 3/2020

Open Access 01-03-2020 | Insulins | Review

A Practitioner’s Toolkit for Insulin Motivation in Adults with Type 1 and Type 2 Diabetes Mellitus: Evidence-Based Recommendations from an International Expert Panel

Authors: Sanjay Kalra, Sarita Bajaj, Surendra Kumar Sharma, Gagan Priya, Manash P. Baruah, Debmalya Sanyal, Sambit Das, Tirthankar Chaudhury, Kalyan Kumar Gangopadhyay, Ashok Kumar Das, Bipin Sethi, Vageesh Ayyar, Shehla Shaikh, Parag Shah, Sushil Jindal, Vaishali Deshmukh, Joel Dave, Aslam Amod, Ansumali Joshi, Sunil Pokharel, Faruque Pathan, Faria Afsana, Indrajit Prasad, Moosa Murad, Soebagijo Adi Soelistijo, Johanes Purwoto, Zanariah Hussein, Lee Chung Horn, Rakesh Sahay, Noel Somasundaram, Charles Antonypillai, Manilka Sumanathilaka, Uditha Bulugahapitiya

Published in: Diabetes Therapy | Issue 3/2020

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Abstract

Aim

To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner’s toolkit for insulin motivation in the management of diabetes mellitus (DM).

Background

Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization.

Review Results

After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy.

Conclusions

In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals.
Literature
1.
go back to reference Home P, Riddle M, Cefalu WT, et al. Insulin therapy in people with type 2 diabetes: opportunities and challenges? Diabetes Care. 2014;37(6):1499–508.PubMedPubMedCentralCrossRef Home P, Riddle M, Cefalu WT, et al. Insulin therapy in people with type 2 diabetes: opportunities and challenges? Diabetes Care. 2014;37(6):1499–508.PubMedPubMedCentralCrossRef
3.
5.
6.
go back to reference Russell-Jones D, Pouwer F, Khunti K, et al. Identification of barriers to insulin therapy and approaches to overcoming them. Diabetes Obes Metab. 2018;20:488–96.PubMedCrossRef Russell-Jones D, Pouwer F, Khunti K, et al. Identification of barriers to insulin therapy and approaches to overcoming them. Diabetes Obes Metab. 2018;20:488–96.PubMedCrossRef
7.
go back to reference Brod M, Kongso JH. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res. 2009;18:23–32.PubMedCrossRef Brod M, Kongso JH. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res. 2009;18:23–32.PubMedCrossRef
8.
go back to reference Polonsky WH, Fisher L, Guzman S, et al. Psychological insulin resistance in patients with type 2 diabetes. Diabetes Care. 2005;28(10):2543–5.PubMedCrossRef Polonsky WH, Fisher L, Guzman S, et al. Psychological insulin resistance in patients with type 2 diabetes. Diabetes Care. 2005;28(10):2543–5.PubMedCrossRef
9.
go back to reference Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational global attitudes of patients and physicians in insulin therapy study. Diabet Med. 2012;29(5):682–9.PubMedPubMedCentralCrossRef Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational global attitudes of patients and physicians in insulin therapy study. Diabet Med. 2012;29(5):682–9.PubMedPubMedCentralCrossRef
10.
go back to reference Karter AJ, Parker MM, Subramanian U, et al. Barriers to insulin initiation. Diabetes Care. 2010;33:33–735.CrossRef Karter AJ, Parker MM, Subramanian U, et al. Barriers to insulin initiation. Diabetes Care. 2010;33:33–735.CrossRef
12.
go back to reference Venkataraman K, Tan LS, Bautista DC, et al. Psychometric properties of the problem areas in diabetes (PAID) instrument in Singapore. PLoS One. 2015;10(9):e0136759.PubMedPubMedCentralCrossRef Venkataraman K, Tan LS, Bautista DC, et al. Psychometric properties of the problem areas in diabetes (PAID) instrument in Singapore. PLoS One. 2015;10(9):e0136759.PubMedPubMedCentralCrossRef
13.
go back to reference Welch GW, Jacobson AM, Polonsky WH. The problem areas in diabetes scale. An evaluation of its clinical utility. Diabetes Care. 1997;20(5):760–6.PubMedCrossRef Welch GW, Jacobson AM, Polonsky WH. The problem areas in diabetes scale. An evaluation of its clinical utility. Diabetes Care. 1997;20(5):760–6.PubMedCrossRef
14.
go back to reference Clark M. Psychological insulin resistance: a guide for practice nurses. Diabetes Nurs. 2007;11(2):53–6. Clark M. Psychological insulin resistance: a guide for practice nurses. Diabetes Nurs. 2007;11(2):53–6.
15.
go back to reference Young-Hyman D, de Groot M, Hill-Briggs F, et al. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40.PubMedPubMedCentralCrossRef Young-Hyman D, de Groot M, Hill-Briggs F, et al. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40.PubMedPubMedCentralCrossRef
16.
go back to reference Hood H, Hillard M, Piatt G, et al. Effective strategies for encouraging behavior change in people with diabetes. Diabetes Manag (Lond). 2015;5(6):499–510.PubMedPubMedCentralCrossRef Hood H, Hillard M, Piatt G, et al. Effective strategies for encouraging behavior change in people with diabetes. Diabetes Manag (Lond). 2015;5(6):499–510.PubMedPubMedCentralCrossRef
17.
go back to reference Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83–90.PubMedCrossRef Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83–90.PubMedCrossRef
18.
go back to reference Channon SJ, Huws-Thomas MV, Rollnick S, et al. A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care. 2007;30(6):1390–5 Epub 10 Mar 2007.PubMedCrossRef Channon SJ, Huws-Thomas MV, Rollnick S, et al. A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care. 2007;30(6):1390–5 Epub 10 Mar 2007.PubMedCrossRef
19.
20.
go back to reference Marrero DG, Mayer-Davis EJ, Ard J, et al. Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes. Diabetes Care. 2013;36(2):463–70.PubMedPubMedCentralCrossRef Marrero DG, Mayer-Davis EJ, Ard J, et al. Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes. Diabetes Care. 2013;36(2):463–70.PubMedPubMedCentralCrossRef
21.
go back to reference Welch G, Rose G, Ernst D. Motivational interviewing and diabetes: what is it, how is it used, and does it work? Diabetes Spectr. 2006;19(1):5–11.CrossRef Welch G, Rose G, Ernst D. Motivational interviewing and diabetes: what is it, how is it used, and does it work? Diabetes Spectr. 2006;19(1):5–11.CrossRef
23.
go back to reference Racic M, Katic B, Joksimovic BN, et al. Impact of motivational interviewing on treatment outcomes in patients with diabetes type 2: a randomized controlled trial. J Fam Med. 2015;2(1):1–6. Racic M, Katic B, Joksimovic BN, et al. Impact of motivational interviewing on treatment outcomes in patients with diabetes type 2: a randomized controlled trial. J Fam Med. 2015;2(1):1–6.
24.
go back to reference Li M, Li T, Shi BY, et al. Impact of motivational interviewing on the quality of life and its related factors in type 2 diabetes mellitus patients with poor long-term glycemic control. Int J Nurs Sci. 2014;1:250–4. Li M, Li T, Shi BY, et al. Impact of motivational interviewing on the quality of life and its related factors in type 2 diabetes mellitus patients with poor long-term glycemic control. Int J Nurs Sci. 2014;1:250–4.
25.
go back to reference Song D, Xu T, Sun Q. Effect of motivational interviewing on self management in patients with type 2 diabetes mellitus: a meta-analysis. Int J Nurs Sci. 2014;1:291–7. Song D, Xu T, Sun Q. Effect of motivational interviewing on self management in patients with type 2 diabetes mellitus: a meta-analysis. Int J Nurs Sci. 2014;1:291–7.
26.
go back to reference Mathew EM. Assessment of medication adherence in type-2 diabetes patients on poly pharmacy and the effect of patient counseling given to them in a multispecialty hospital. J Basic Clin Pharm. 2014;5(1):1–15.CrossRef Mathew EM. Assessment of medication adherence in type-2 diabetes patients on poly pharmacy and the effect of patient counseling given to them in a multispecialty hospital. J Basic Clin Pharm. 2014;5(1):1–15.CrossRef
28.
go back to reference Palacio A, Garay D, Langer B, et al. Motivational interviewing improves medication adherence: a systematic review and meta-analysis. JGIM. 2016;31(8):929–40.PubMedCrossRefPubMedCentral Palacio A, Garay D, Langer B, et al. Motivational interviewing improves medication adherence: a systematic review and meta-analysis. JGIM. 2016;31(8):929–40.PubMedCrossRefPubMedCentral
29.
go back to reference Chan WB, Chen JF, Goh S, et al. Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience. Diabetes Metab Syndr Obes. 2017;10:521–32.PubMedPubMedCentralCrossRef Chan WB, Chen JF, Goh S, et al. Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience. Diabetes Metab Syndr Obes. 2017;10:521–32.PubMedPubMedCentralCrossRef
30.
go back to reference Insulin myths and facts. Patient information. Clin Diabetes. 2007;25(1):39–40.CrossRef Insulin myths and facts. Patient information. Clin Diabetes. 2007;25(1):39–40.CrossRef
31.
go back to reference Snoek FJ, Skovlund SE, Pouwer F. Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes. Health Qual Life Outcomes. 2007;5:69.PubMedPubMedCentralCrossRef Snoek FJ, Skovlund SE, Pouwer F. Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes. Health Qual Life Outcomes. 2007;5:69.PubMedPubMedCentralCrossRef
34.
go back to reference Hojat M, Louis DZ, Markham FW, et al. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359–64.PubMedCrossRef Hojat M, Louis DZ, Markham FW, et al. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359–64.PubMedCrossRef
35.
go back to reference Garg SK, Admane K, Freemantle N, et al. Patient-led versus physician-led titration of insulin glargine in patients with uncontrolled type 2 diabetes: a randomized multinational atlas study. Endocr Pract. 2015;21:143–57.CrossRefPubMed Garg SK, Admane K, Freemantle N, et al. Patient-led versus physician-led titration of insulin glargine in patients with uncontrolled type 2 diabetes: a randomized multinational atlas study. Endocr Pract. 2015;21:143–57.CrossRefPubMed
36.
go back to reference Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38:140–9.PubMedCrossRef Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38:140–9.PubMedCrossRef
38.
go back to reference Dalal MR, Kazemi M, Ye F, et al. Hypoglycemia after initiation of basal insulin in patients with type 2 diabetes in the United States: implications for treatment discontinuation and healthcare costs and utilization. Adv Ther. 2017;34(9):2083–92.PubMedPubMedCentralCrossRef Dalal MR, Kazemi M, Ye F, et al. Hypoglycemia after initiation of basal insulin in patients with type 2 diabetes in the United States: implications for treatment discontinuation and healthcare costs and utilization. Adv Ther. 2017;34(9):2083–92.PubMedPubMedCentralCrossRef
39.
go back to reference Brod M, Rana A, Barnett AH. Adherence patterns in patients with type 2 diabetes on basal insulin analogues: missed, mistimed and reduced doses. Curr Med Res Opin. 2012;28(12):1933–46.PubMedCrossRef Brod M, Rana A, Barnett AH. Adherence patterns in patients with type 2 diabetes on basal insulin analogues: missed, mistimed and reduced doses. Curr Med Res Opin. 2012;28(12):1933–46.PubMedCrossRef
40.
go back to reference Association The American Diabetes. Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Suppl. 1):S4–6. Association The American Diabetes. Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Suppl. 1):S4–6.
41.
go back to reference Hernandez-Tejada MA, Campbell JA, Walker RJ, et al. Diabetes empowerment, medication adherence and self-care behaviors in adults with type 2 diabetes. Diabetes Technol Ther. 2012;14(7):630–4.PubMedPubMedCentralCrossRef Hernandez-Tejada MA, Campbell JA, Walker RJ, et al. Diabetes empowerment, medication adherence and self-care behaviors in adults with type 2 diabetes. Diabetes Technol Ther. 2012;14(7):630–4.PubMedPubMedCentralCrossRef
44.
go back to reference Baser O, Tangirala K, Wei W, et al. Real-world outcomes of initiating insulin glargine-based treatment versus premixed analog insulins among US patients with type 2 diabetes failing oral antidiabetic drugs. Clinicoecon Outcomes Res. 2013;5:497–505.PubMedPubMedCentralCrossRef Baser O, Tangirala K, Wei W, et al. Real-world outcomes of initiating insulin glargine-based treatment versus premixed analog insulins among US patients with type 2 diabetes failing oral antidiabetic drugs. Clinicoecon Outcomes Res. 2013;5:497–505.PubMedPubMedCentralCrossRef
Metadata
Title
A Practitioner’s Toolkit for Insulin Motivation in Adults with Type 1 and Type 2 Diabetes Mellitus: Evidence-Based Recommendations from an International Expert Panel
Authors
Sanjay Kalra
Sarita Bajaj
Surendra Kumar Sharma
Gagan Priya
Manash P. Baruah
Debmalya Sanyal
Sambit Das
Tirthankar Chaudhury
Kalyan Kumar Gangopadhyay
Ashok Kumar Das
Bipin Sethi
Vageesh Ayyar
Shehla Shaikh
Parag Shah
Sushil Jindal
Vaishali Deshmukh
Joel Dave
Aslam Amod
Ansumali Joshi
Sunil Pokharel
Faruque Pathan
Faria Afsana
Indrajit Prasad
Moosa Murad
Soebagijo Adi Soelistijo
Johanes Purwoto
Zanariah Hussein
Lee Chung Horn
Rakesh Sahay
Noel Somasundaram
Charles Antonypillai
Manilka Sumanathilaka
Uditha Bulugahapitiya
Publication date
01-03-2020
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 3/2020
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-020-00764-7

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