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 On average, these patients delay insulin for about two years,
researchers report in Diabetic Medicine.
“This matters to patients because insulin therapy is typically
offered to patients with high blood sugar levels,” said senior study
author Dr. Alexander Turchin of Brigham and Women’s Hospital and
Harvard Medical School in Boston.
“If the patient does not start insulin therapy and does not initiate
any other changes to bring their blood sugar levels down, their
blood sugar can stay high for years, leading to diabetes
complications such as blindness, kidney failure and heart attacks,”
Turchin said by email.
Globally, about one in 10 adults have diabetes, according to the
World Health Organization. Most have type 2 diabetes, which is
associated with obesity and aging and occurs when the body can’t
make or process enough of the hormone insulin.
Medications as well as lifestyle changes such as improved diet and
exercise habits can help manage diabetes and keep symptoms in check.
When diabetes isn’t well managed, however, dangerously high blood
sugar can eventually lead to blindness, amputations, kidney failure,
heart disease and stroke.
While some previous research has found diabetics often fail to start
insulin when it’s needed, it’s been unclear how much of this is due
to doctors failing to prescribe the medication versus patients
refusing to take it, Turchin said.
For the current study, researchers examined data from electronic
physician notes at Brigham and Women’s Hospital from 2000 to 2014.
Of the 3,295 patients with diabetes included in the analysis, nearly
one third declined a physician’s advice to begin insulin at the time
the recommendation was made, researchers report in Diabetic
Medicine.
People who initially declined, but ultimately accepted the
recommendation to start insulin, started the insulin therapy more
than two years later, on average, during which time their blood
glucose levels climbed.
Sanofi, which sells insulin products, funded the study.
The study wasn’t a controlled experiment designed to prove whether
or how delaying insulin impacts the course of diabetes or patients’
health.
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Another limitation is the potential that results from one medical
center might not reflect what happens for a broader population of
patients, the authors note.
It’s also possible that some patients declined insulin but this
wasn’t noted in their medical records, leading the study to
underestimate how often this occurs. Patients’ reasons for declining
or delaying insulin were unknown.
Some patients might reject insulin because they’re afraid of needles
or injections, or because they mistakenly think insulin causes
diabetes complications, said Dr. Simon Heller, a diabetes researcher
at the University of Sheffield in the UK who wasn’t involved in the
study.
“They mistakenly think that insulin is the cause instead of
understanding that complications have developed because blood sugar
has been high for years,” Heller said by email.
Patients need to understand that insulin can help them quickly feel
better and get their diabetes under control, said Dr. Vanessa
Arguello, an endocrinologist at the David Geffen School of Medicine
at University of California, Los Angeles, who wasn’t involved in the
study.
But there’s a lot people can do to minimize the odds that they will
need insulin, Arguello said by email.
“The key to avoiding insulin begins with making lifestyle changes
early in the disease process – this can be as early as when people
are diagnosed with pre-diabetes,” Arguello said. “It is immensely
rewarding to see the positive effects form a carbohydrate-controlled
diet, exercise, and weight loss on type 2 diabetes control - plus
collectively it’s the most inexpensive option for optimal glucose
control.”
SOURCE: http://bit.ly/2fyHvVs Diabetic Medicine, online September
14, 2017.
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