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EASD Recommends Earlier Insulin Therapy, Don’t Wait 4-6 years!

Posted: Thursday, September 28, 2006

A Consensus Report launched at the annual meeting of the European Association for the Study of Diabetes, in Copenhagen, Denmark, is calling for urgent action to drastically improve the management of diabetes, particularly urging the increased acceptance of insulin. All patients with Type 2 diabetes, if they live long enough will require insulin.

The Report, a rallying cry to the global medical community, was produced by a panel of 25 diabetes experts from 16 different countries, who convened to tackle the growing diabetes epidemic, which is estimated to consume $286 billion from worldwide health care budgets each year.

The coalition was formed to look at ways to address this worrying burden using the results of the Pfizer-sponsored OPTIMIZE survey, in which almost 1,500 people with type 2 diabetes from seven countries were questioned about their attitudes to diabetes management, and found significant patient barriers to achieving optimal blood sugar control, with patient resistance to injections being the most significant amongst them.

William Cefalu, of the Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA, and chairman of the OPTIMIZE panel, explained that "diabetes is a progressive disease and almost all patients with type 2 diabetes who are currently controlling their condition through diet, exercise and oral therapy will ultimately require insulin, the gold standard treatment for the successful management of diabetes."

The typical progression of the disease involves a period of impaired glucose tolerance before diabetes can be clearly diagnosed. In the early stages of the chornic disorder, monotherapy and then dual therapy all offer adequate glycemic control. But diabetes is caused by an underlying deterioration in the mass of insulin-secreting cells in the pancreas and, once the body's ability to secrete enough of this glucose-lowering hormone is diminished, insulin has to be introduced as part of a patient's therapy.

However, Prof Ceflau stressed that "a treatment is only successful if patients are willing to use it. Recent clinical research shows that half of patients for whom oral diabetes medicines are not sufficient for them to reach blood sugar targets are delaying for at least four to six years before commencing insulin treatment. Even patients who are suffering from the complications of uncontrolled diabetes, such as neuropathy and retinopathy, which can lead to blindness, are still delaying insulin treatment."
The OPTIMIZE Survey, which looked at patient attitudes to diabetes management, reinforced this data and revealed serious issues surrounding the acceptance of insulin. Another OPTIMIZE panel member, Chantal Mathieu, from the University of Leuven, Belgium, explained how, "sadly, people with type 2 diabetes have learned to fear insulin rather than seeing it as an effective treatment that can help them maintain optimal blood sugar control."

"Injection-related failures" - major barrier to insulin acceptance.

Prof Mathieu, noted that "this fear has been perpetuated by some doctors who use insulin therapy as a threat to promote compliance during the early stages of diabetes but in fact insulin is the most effective and natural way of controlling blood sugar. The OPTIMIZE Consensus Report highlights that reluctance to use or intensify insulin treatment is often due to injection-related factors. We must dispel these fears and improve the management of diabetes, which includes increasing acceptance of insulin by communicating its use as an optimal treatment, if we are to reduce the ever-increasing burden of this disease."

Landmark trials have unequivocally proved that poor blood sugar management, for which insulin is the gold standard, leads to diabetes-related complications such as blindness, amputations, kidney failure, heart attack and nerve damage. This suggests that widepsread patient resistance to injections is the root cause of the disease's $286 billion annual cost burden.

The OPTIMIZE Consensus Report discusses key actions to help overcome the barriers to optimal blood sugar control such as creating a receptive environment. The panel suggests that public awareness and patient empowerment must be improved, while health care professionals must receive better education about insulin and the barriers to treatment so they can communicate the importance of optimal blood sugar control to patients.

Also discussed in the report is patient education on the importance of getting to goal, helping improve patient understanding that insulin treatment may eventually be needed due to the nature of diabetes and that this eventuality should be discussed as early as possible, while patient preference should be an integral part of treatment decisions to encourage accurate self management. The OPTIMIZE report goes further by suggesting that new non-injectable insulin therapies, as a way of increasing acceptance of insulin, could lead to better outcomes.

The Reports' suggestions are good news for world drug giant Pfizer which, together with Nektar Therapeutics, co-developed Exubera, the first and only approved inhaled insulin. The Report echoes data which Pfizer presented at the 66th annual scientific sessions of the American Diabetes Association showing that many type 2 diabetics who need insulin avoid injections for at least four years or more, despite insulin's proven effectiveness.

Pfizer reviewed 2,501 anonymous patient records from more than 100 general practices of the UK's National Health Service database over a 17-year period and found that half of patients delayed starting insulin for at least four years after their diabetes pills failed to be effective, even if they already suffered from economically-costly diabetes-related complications (Marketletter June 19).



Source: Diabetes In Control: Presented at the European Association for the Study of Diabetes 2006 Meeting.

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