Strategies to Improve Glucose Control with Mealtime Insulin
October 12, 2021 · NCQA Communications
The Situation
Clinicians who treat individuals with types 1 and 2 diabetes (T1D, T2D) need expert guidance to evaluate, interpret the clinical significance, and apply emerging data and evolving best practices to effectively initiate mealtime insulin (MTI) with ultra-rapid analogs and optimize its effectiveness.
Despite the serious consequences of poor glycemic control and the fact that achieving glycated hemoglobin (HbA1c) goals <7% can reduce both macrovascular and microvascular events, an alarmingly high proportion of patients fail to do so. One study based on a retrospective analysis of administrative data from patients with diabetes enrolled in a large health plan showed that 56.1% of patients had poor glycemic control although they were adherent to their medications.
But failure to adhere to the regimen also plays a major role in poor glycemic control. Although the etiologies of T1D and T2M are very different, both diseases result in hyperglycemia. T1D is always treated with insulin, but T2M may be treated with a variety of oral medications, as well as insulin.
While insulin is a highly effective therapy, it is used by less than 50% of patients for whom it is recommended. In a retrospective health plan analysis, insulin was used by 54.7% of those achieving an HbA1c level ≤ 7% but only 26.3% of those with an HbA1c >7%. Guidelines recommend intensification of therapy for patients who do not achieve glycemic goals within 3 months or 3 to 6 months after treatment initiation, as delayed treatment intensification in poorly controlled patients is associated with an increased risk of diabetes-related complications later in life. Yet studies indicate that patients often remain above glycemic targets for several years before intensification is initiated.
Education for Clinicians
We are pleased to announce the launch of Strategies to Improve Glucose Control with Mealtime Insulin, a Medical Learning Institute, Inc. continuing education initiative in partnership with the Endocrine Society and the National Committee for Quality Assurance.
This CME/NCPD/CPE activity includes five interactive, microlearning modules addressing care and outcomes for individuals with diabetes treated with ultra-rapid insulin analogs at mealtime. The modules incorporate case studies and embedded questions for an active learning experience. Learners can choose to participate in one or more of the modules to address their educational interests and needs based on their scope of practice and patient population.
