Editorial

Steven V. Edelman, MD, and Derek LeRoith, MD, PhD

The transitioning, in a timely and efficient manner, of patients who are not achieving glycemic goals using oral antidiabetic agents alone to treatment with insulin is unquestionably one of the greatest challenges in diabetes care. We are excited to present this issue of Insulin that focuses not only on practical insulin treatment strategies but also highlights many of the barriers that prevent adequate diabetes care in this country.

Clinical inertia—defined as the recognition of a problem but failure to act—is addressed, with suggestions for overcoming this common occurrence in modern medicine. Defining goals, instituting time frames for progress, and publicly displaying results are 3 of the guidelines examined in detail. Narrowing the cultural divide by addressing the disparities in health care in the Hispanic/Latino community is also an issue not normally discussed in a medical journal such as this. However, we feel this is a worthwhile topic because these disparities severely affect what is currently the largest—and still growing—minority group in the United States. Lastly, instituting insulin therapy earlier in the natural course of type 2 diabetes mellitus and the role of basal insulin therapy are discussed in detail, with useful ideas that have proven successful in clinical practice.

It is not enough to publish only the data and demographics from clinical trials. It is the emotional barriers associated with diabetes care, the clinical inertia, the disparities in treatment, the deep-rooted cultural beliefs, and the resistance to initiating insulin by the caregiver that truly limit our ability to achieve glycemic control in the majority of our patients with diabetes.

We hope this issue of Insulin adequately addresses some of these nontraditional but very important topics of patient care.

The Role of Basal Insulin Therapy in Patients with Type 2 Diabetes Mellitus
Vivian Fonseca, MD

Basal insulins, both intermediate- and long-acting formulations, are playing an increasingly important role in the treatment of type 2 DM.

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Clinical Inertia: Overcoming a Major Barrier to Diabetes Management
Charles F. Shaefer, Jr., MD, FCCP, FACP

Although various psychological and system barriers can slow the physician from rapidly achieving established therapeutic goals, the simple strategies outlined here can eliminate many of the confounding factors that hinder aggressive management.

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A Case for Introducing Insulin Early in the Treatment of Type 2 Diabetes Mellitus
Sydney A. Westphal, MD, Pasquale J. Palumbo, MD

With a more aggressive approach to starting and intensifying insulin therapy, patients may be more likely to achieve and maintain glycemic goals, thereby reducing the development of DM complications. Over time, this intervention may lead to healthier and longer lives for patients with type 2 DM.

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Narrowing the Cultural Divide in Diabetes Mellitus Care: A Focus on Improving Cultural Competency to Better Serve Hispanic/Latino Populations
Carlos Campos, MD, MPH

Effective communication by DM care providers and efforts to improve health literacy among patients can often lead to improvements in DM management, with an emphasis on achieving glycemic control and reducing the risk for DM-related complications.

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Response to Previous Case Study
Derek LeRoith, MD, PhD

Rocio Pereira presents an interactive case study involving the use of insulin in a 29-year-old Hispanic woman with DM. Readers are encouraged to consider the accompanying questions and to submit their response for consideration by a diabetes expert.

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How to Adjust Your Insulin Dosages

Susan Renda, MS, CRNP, CDE

Diabetes means your body is unable to produce enough insulin to keep your blood sugar (glucose) at the proper levels. If you have type 1 diabetes mellitus (DM), you will need to use insulin right from the start.

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