A look into the future: improving diabetes care by 2015

Abstract

Insulin initiation, which was traditionally the province of specialists, is increasingly undertaken by primary care. However, significant barriers to appropriate and timely initiation still exist. Whilst insulin is recognized as providing the most effective treatment in type 2 diabetes, it is also widely considered to be the most challenging and time consuming. This editorial identifies that the organization of existing healthcare services, the challenges faced by patients, and the treatments themselves contribute to suboptimal insulin management. In order to improve future diabetes care, it will be necessary to address all three problem areas: (1) re-think the best use of existing human and financial resources to promote and support patient self-management and adherence to treatment; (2) empower patients to participate more actively in treatment decision making; and (3) improve acceptance, persistence and adherence to therapy by continuing to refine insulin therapy and treatment regimens in terms of safety, simplicity and convenience. The principles discussed are also applicable to the successful management of any chronic medical illness.

Key words::

• Healthcare
• Insulin
• Non-adherence
• Oral antidiabetic drug
• Self-management
• Therapy adherence
• Type 2 diabetes mellitus

Transparency

Declaration of funding

This paper represents the consensus opinion of a multidisciplinary team of experts in diabetes care who met in November 2010 to identify, discuss and put forward solutions to problems with insulin management in patients with diabetes. The meeting and medical writing assistance was organized and funded by Novo Nordisk.

Declaration of financial/other relationships

The authors disclose the following consulting income, honoraria, and/or grant support: C.T. – Novo Nordisk; W.J. – Novo Nordisk; A.H.B. – Eli Lilly, Novo Nordisk and Sanofi Aventis; S.B. – Novo Nordisk; S.G. – Novo Nordisk; D.H. – BD, BMS/AZ, Eli Lilly, Lifescan, MSD, Novo Nordisk, Roche, Sanofi-Aventis, and Takeda; E.M. – Amylin, BMS/AZ, Eli Lilly, and Novo Nordisk; M.P. – Amylin, Animas, CPEX, Eli Lilly, Genentech, Healthy Interactions, MannKind, Medtronic, Novo Nordisk and Patton Medical Devices; D.S. – Novo Nordisk; P.M.S.-D. – Berlin Chemie, Eli Lilly, Novo Nordisk and Sanofi Aventis.

Acknowledgements

This Diabetes Consensus Group comprised Stephen Brunton, Etie Moghissi, Debbie Hicks, Christine Tobin, Stephen Gough, Weng Jianping, Doron Schneider, Petra Maria Schumm-Draeger, Mark Peyrot, and Tony Barnett. All participants of the meeting have contributed directly to preparing this manuscript and/or reviewing the manuscript for scientific and historical accuracy. The authors would like to thank Christopher M. Burton from Point Of Care Medical Consulting for providing medical writing assistance.