Initiation and intensification of insulin therapy in type 2 diabetes mellitus: Physician barriers and solutions – An Indian perspective

The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide, and its complications are highly contributing to mortality. Compared to oral hypoglycemic agents, reduction in HbA1c is maximum with insulin therapy. Evidence suggests the potential benefits of achieving normoglycemia with early intensive insulin therapy. Despite the high levels of uncontrolled T2DM in Indian patients, the use of insulin remains suboptimal. Initiation of insulin therapy in patients with T2DM is often inappropriately delayed due to physician's barriers. These include physicians’ inadequacy of skill and time required for insulin therapy, perceived complications of insulin therapy and perceived lack of treatment benefit. These barriers can be overcome by physician education and training, using effective patient education methods and tools, and bridging gaps to improve adherence by the patients. Pharmaceutical industry, government health authorities, medical institutions, healthcare professionals and patients can help to overcome the clinical inertia for the initiation and titration of insulin in patients with type 2 diabetes.