A new look at established therapies: practical tools for optimizing insulin use.

Purpose: Current evidence shows early initiation of insulin therapy in type 2 diabetes mellitus (T2DM) improves glycemic control, responsiveness to subsequent oral antidiabetic therapies, beta-cell function, and possible cardiovascular outcomes. The American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2008 algorithm introduces insulin therapy earlier in the treatment of T2DM with prompt intensification to achieve therapeutic goals. Agent selection and insulin regimens are based on patient A1C levels and willingness to monitor blood glucose, use of previous medications, blood glucose patterns, diet, and lifestyle. Practical considerations offered for diabetes educators and clinicians include creating strategies for early initiation of insulin, addressing patients' psychosocial barriers and quality of life concerns, understanding pharmacokinetic properties of insulin formulations, selecting appropriate therapy and patient-based regimens, and intensifying therapy to achieve glycemic control.

Conclusions: Diabetes education, including intentional curriculum design, for patients with T2DM who are initiating or intensifying insulin therapy, addresses patient barriers to care, reduces the burden of treatment, improves adherence to treatment protocols, and helps optimize clinical outcomes.