Free Health Dissertations - Chapter Four Reasons For Delay In Insulin Therapy Although The Reasons For
CHAPTER FOUR REASONS FOR DELAY IN INSULIN THERAPY
Although the reasons for poor glucose control amongst diabetics is complex, one concerning issue remains the reluctance of physicians and patients to begin insulin therapy. This has been widely documented, despite awareness amongst both caregivers and Type 2 diabetics of the increased health risks caused by inadequate glucose control.
Diabetes, and the complications caused by poor management of the disease, are rapidly becoming a health concern of epidemic proportion in Europe and the United States. According to Celafu (2004), normal glucose levels are seldom maintained over time in Type 2 diabetics. Even with early intervention and education, many patients with type 2 diabetes are unable to achieve treatment goals through lifestyle changes alone (Anon 2005, 4). Oral antidiabetic drugs, the initial treatment for Type 2, eventually fail to provide adequate glycemic control (Anon 2005, 4). Targets are missed both due to the progressive nature of the disease and to a reluctance to initiate insulin therapy (Davies 2004).
Davies (2004, S15), citing an unpublished study by the British Diabetic Association, reports that in the UK a large dataset of over 600, 000 from across the country in the year 2000 reported a mean HbA1c of 8.6 in type I patients and 7.8 in type II patients. This is significantly above the 6.5 recommended (Davies 2004).Funnell and Kruger (2004) similarly report that over half the Type 2 diabetics in the United States regularly exceed recommended glycemic goals, such as an A1C of less than 7%. However, they cite three large independent trials which all show significant A1C improvement with the introduction of insulin therapy (Funnell and Kruger 2004).
Results from the 1998 UK Prospective Diabetes Study suggests that even a 1% Hb reduction can lead to a 21% reduction in diabetes-related death (Stratton et al 2000). Similar reductions also result in a 14% reduction in myocardial infarction, and up to a 37% reduction in microvascular complications (Stratton et al 2000). Reductions in peripheral vascular disease by over 40% are also cited (Stratton et al 2000).According to Davies (2004, S14), a number of studies show unequivocally that reducing hyperglycemia reduces both the incident risk and progression of diabetic complications, with no threshold level of HbA1c beneath which further prognostic advantage cannot be achieved.
Given the scope of the problem, clinicians need to identify type 2 diabetes early and initiate aggressive intervention to positively influence patients at risk for the disease and help prevent disease progression and associated complications (Anon 2005, 3). In order to achieve the suggested targets for glycemic control necessary to reduce the incidence of diabetic complications, it has been established that a more intensive insulin regimen and earlier use of insulin is often called for (Cefalu 2004, 1149).
Dissertations - Free Health Dissertations
