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Injectable therapy in diabetes management

Injectable therapy in diabetes management. Treatment path in type 2 diabetes. GLP-1 receptor agonists. Lifestyle changes Diet & exercise. OADs. Insulin. OAD, oral antidiabetic drug. What reaction does ‘injectable therapy’ provoke?. It’s the last resort. Patients don’t like it.

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Injectable therapy in diabetes management

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  1. Injectable therapy in diabetes management

  2. Treatment path in type 2 diabetes GLP-1 receptor agonists Lifestyle changes Diet & exercise OADs Insulin OAD, oral antidiabetic drug

  3. What reaction does ‘injectable therapy’ provoke?

  4. It’s the last resort Patients don’t like it It takes too long to teach Tablets are easier

  5. The most cited reasons by Diabetes Consultants, GPs and Nurses for delaying starting insulin is… patients’ resistance to injections Novo Nordisk data on file 2008

  6. Patient: Which, if any, of the following were you concerned about or afraid of when you were told you needed to start taking insulin? Base: All UK patients (n = 205) Novo Nordisk Global Attitudes of Patients and Physicians in Insulin Therapy (GAPP™) Survey Results 2010

  7. Patient: Which, if any, of the following were you concerned about or afraid of when you were told you needed to start taking insulin? Base: All UK patients (n = 205) Novo Nordisk Global Attitudes of Patients and Physicians in Insulin Therapy (GAPP™) Survey Results 2010

  8. Patient: What would you say are the biggest challenges you face in effectively treating and managing your diabetes with insulin? Base: All UK patients (n = 205) Novo Nordisk Global Attitudes of Patients and Physicians in Insulin Therapy (GAPP™) Survey Results 2010

  9. Insulin perceptions questionnaire • A useful tool to identify potential fears/concerns which can then be addressed before insulin therapy is required

  10. Reducing injection anxiety • Reassure that many patients have concerns • Ensure patient understands benefits of medicine in question • injectables generally have a greater impact on HbA1c than tablets • Consider a once daily injection • Consider a medicine that minimises risk of hypoglycaemia • Show patient an injection device and needle • patients often form their view on injections when they’re very young (i.e. small child, giant needle!) • Highlight that insulin is injected into subcutaneous fat • Get first injection out of the way as soon as possible • If patient has severe needle phobia, consider referral to secondary care (but remember, this is rare!)

  11. Both you and your patients may be surprised When compared with patients receiving oral sitagliptin, a greater number of patients receiving injectable liraglutide 1.8 mg: • reported greater treatment satisfaction (difference: 0.35; p=0.01) • would recommend their treatment (difference: 0.41; p=0.003) • would continue with their treatment (difference: 0.44; p=0.01) The above mentioned 3 differences were not observed when liraglutide 1.2 mg was compared to sitagliptin There was no difference in treatment satisfaction relating to flexibility or treatment convenience Davies et al.,Diabetic Medicine DOI: 10.1111/j.1464-5491.2010.03074.x

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