Q&A: Are People with Type 2 Diabetes Receiving the Best Medicine and Tools for Their Care?

Healthline recently conducted a broad survey on the State of Type 2 Diabetes to explore how well millions of Americans are faring with this confounding condition.

An important theme that came forward in this survey of more than 1,500 people living with type 2 diabetes is that barriers to top-quality care come not only in the form of financial and access challenges (like insurance), but also from fears and negative perceptions among people with diabetes and healthcare providers alike.

Key Findings:

  • 43% feel that needing insulin means that they have failed in managing type 2 diabetes
  • 32% never tried and would not consider trying any injectable medication (including insulin)
  • 56% never tried and would not consider trying an insulin pump
  • 45% never tried and would not consider trying inhalable insulin
  • 43% never tried and would not consider trying a telemedicine, telehealth or virtual health program

To explore these issues further, we talked recently with three diabetes experts:

Susan Weiner, registered dietitian and nutritionist, author and award-winning certified diabetes educator (CDE);

Amy Tenderich, founder of the patient information site DiabetesMine, and a nationally known advocate focused on innovation in diabetes tools;

Cindy Campaniello, a person with type 2 diabetes in New York who is active with the DiabetesSisters group for women with diabetes.

Here’s what they had to say:

Q: The best medications to manage type 2 diabetes depend on someone’s blood sugar levels and overall health. Years ago, insulin therapy was viewed as a scare tactic, but today it is more readily prescribed because of its benefits and advantages for improved diabetes management. Have you encountered healthcare providers who discuss insulin as a last resort for treatment?

SUSAN: It’s true that some people with type 2 diabetes fear that the need for insulin means that they have somehow failed in their own self-care. In some cases, healthcare providers or physicians may make incorrect assumptions about a person’s diabetes self-care management. Or the physician may be concerned about side effects associated with insulin, such as hypoglycemia (low blood sugar), or lack of healthcare system support to administer insulin.

Some people with type 2 diabetes may have a misguided fear that taking insulin actually causes complications. This association may occur because they’ve known people on insulin in the past who may have had long-term complications, such as blindness. Education is key here, to explain that insulin is helping to manage high blood sugars, not causing issues associated with them.

CINDY: What I’m hearing from my fellow type 2 friends is that they’re still hearing insulin as a negative threat in their treatment. It’s sad because in my opinion, and for me personally, it’s very effective in the treatment of my diabetes.

Q: Many people don’t like needles and avoid treatments that require injections. Given this, is there any reason why inhalable insulin didn’t catch on as much as the industry thought it would?

SUSAN: Many people with type 2 diabetes, as well as providers, are comfortable with injectable medications, including insulin. However, they may not be accustomed to using insulin as an inhaled medication.

Also, some people with type 2 diabetes may already be taking multiple daily injections (MDIs), and may be confused about properly dosing inhaled insulin. Others are concerned about the side effects of a cough and dry throat. New versions of inhaled insulin look much more promising in terms of dosing and ease of use.

AMY: Unfortunately, the first version of inhaled insulin on the market did not perform because it was clunky and user unfriendly. With advances in the field, a new device has been introduced that’s about the size of a handheld whistle and has color-coded dosing cartridges. Even with these improvements, it has still been an uphill battle to gain traction due to lingering doubts left by the first failed product, and concerns over lung safety.

But clinical data shows it is quite safe and effective, and patients using it have reported very positive outcomes on both glucose levels and quality of life. There’s also a newer version of inhaled insulin in the works that will be a ‘soft mist’ that’s reported to very accurately mimic the natural absorption of insulin in the body.

Read our DiabetesMine article on The Story of Inhaled Insulin for more on this.

Q: Pump and pen technology continues to evolve and there are more great choices today for these devices than ever before. But many people with type 2 diabetes who require insulin aren’t familiar with, or using, these products. Aside from cost, what barriers are keeping people from using these tools?

SUSAN: Similar to the negative perception of starting insulin, people with type 2 diabetes may hear from a friend or family member that if you’re going on a pump, you must have poorly managed diabetes. This is simply not true.

People with diabetes may feel like they’ve failed when their blood glucose is out of a target range, even when they’re following a low carb diet, exercising and following other lifestyle recommendations. But diabetes is not always 100% under behavioral management. So many other factors are involved, including hormone levels, sick days and sleep patterns, just to name a few! We really need to get the word out that pumps and pens are powerful tools to help people with diabetes improve their diabetes management and health.

CINDY: Doctors and insurance companies are our biggest barriers to pumps and other devices in my belief. I believe we can make great strides in our A1C levels (average glucose levels) and in our overall daily care with diabetes if we can improve access to these tools.

Q: Continuous glucose monitoring (CGM) use for people with type 2 diabetes has been a hugely debated issue. Yet there is a ton of possible improvement in diabetes management that can be achieved from wearing one. What’s standing in the way of people using these up-to-date devices?

AMY: Some experts have traditionally asserted that for people with type 2–especially those not taking insulin–CGM is an unnecessary expense. Insurers latched onto that and declined to cover CGM for their type 2 patients, until very recently when Medicare made the decision to open the door to that coverage.

There’s growing clinical evidence that type 2s using CGM reduce calorie intake, increase exercise time, lose weight, and lower A1C results. CGM is an important tool for both patients and doctors to understand glucose reactions and trends.

CINDY: Doctors and insurance companies again are standing in our way of utilizing these great tools. Type 2s should be afforded the same tools to successfully manage their diabetes as type 1s.

Q: Emerging diabetes tech is progressing rapidly and there are so many connected digital tools and apps on the market today. Are people generally aware of these tools? How are people feeling about them? What is their understanding of how these tools can help with their lifestyle and condition management?

SUSAN: While technology can be a wonderful tool to help people with type 2 diabetes keep track of what they’re eating and how much they’re moving, it can be overwhelming and become a time robber. When apps become ‘judgmental’ or just throw back numbers all day long, it may become discouraging.

Social media also puts your life on display and can make some people feel like they’re not accomplishing what someone else has achieved. I would suggest keeping an eye on your app use and social media consumption, especially if it’s interfering with your emotional or physical health.

CINDY: If patients aren’t connected and involved in social media, they aren’t aware of the apps and technology available to them. Doctors in my experience never discuss apps or any other tools that could be effective in helping us with our daily management. Most of the people I know are very connected to their apps but they have found them through social media.

Interested in learning more? Send us an email at advertise@healthline.com to find out more insights into unique patient experiences and treatment challenges.

Source: Healthline’s ‘State of Type 2 Diabetes’ Survey. Survey respondents (n=1,570) were recruited from Survey Sampling International’s consumer panel from June 8 – June 18, 2018.

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