Intensifying insulin treatment: options, practical issues, and the role of the nurse practitioner.

PURPOSE: Failure to achieve and maintain glycemic targets in patients with type 2 diabetes (T2D) is a major clinical issue. Effectively combating the barriers that postpone timely intensification, and educating patients on available treatment options, are key roles of the nurse practitioner. This article summarizes practical considerations in the management of T2D at this stage. DATA SOURCES: Published guidelines for the management of T2D, primary and review articles, and Food and Drug Administration (FDA) prescribing information.
CONCLUSIONS: In patients receiving insulin therapy not achieving targets despite dose titration, a change in insulin regimen may be necessary to achieve clinical targets while minimizing hypoglycemia and weight gain. Whichever strategy is initiated first must be tailored to the individual and include on-going monitoring to manage both hyperglycemia and hypoglycemia. In addition to considerations of glycemic control, the timing and method of insulin intensification will depend on patient willingness, overall health status, meal patterns and routines, and risk of hypoglycemia. Common patient barriers to insulin intensification include regimen complexity and increased risk of hypoglycemia and weight gain. IMPLICATIONS FOR PRACTICE: Support and education on available treatment regimens are key to achieve a comfort level with intensifying insulin therapy that will lead to improved treatment adherence. ©2012 The Author Journal compilation ©2012 American Academy of Nurse Practitioners.