Day: February 18, 2010

MDM in practice, Reflections on MDM, Views from the frontline of care

Why patients with diabetes skip insulin doses?

While the study design cannot provide an in-depth picture (a qualitative analyses would), this Internet survey sought to identify correlates of why people would skip insulin doses (which a substantial proportion of patients reported doing: 57%; 20% reported skipping doses regularly).   Of note for our discussions in this blog is the prominence patients give to interference with daily activities.  This indicates patients directly indicating that a cause for nonadherence is the disruption to their lives caused by insulin use.

With very thin data to support this recommendation, many diabetologists are promoting the early use of insulin in patients with type 2 diabetes, the most common form of diabetes.  Since insulin use requires closer monitoring of blood sugars to manage the dose of insulin and avoid and manage low blood sugars, insulin-containing programs may be quite disruptive.  This paper adds that injecting the insulin can also be disruptive (in terms of effort and schedule I suspect given the correlation with more frequently prescribed injections) and embarrassing to some.

In my practice, I tried to address this with my patients, particularly those who need insulin to avoid symptoms of high blood sugars.  For these patients, I suggest the use of insulin pens and, when appropriate, insulin pumps.  However, the cost of these technologies has made them less accessible to my patients in these times of economic crises.  Thus, clinicians would have to review with patients their goals of care to determine whether, when, and how should insulin be used to manage their diabetes.  Calls for early use to protect the beta cell seem to ignore or at best place a lower value on avoiding or minimizing these challenges.

MDM in practice, Reflections on MDM, Views from the frontline of care

Lack of treatment fit also impacts smoking cessation tools

CNN reports on the death of the captain of the ship featured in the TV show “The Deadliest Catch” from complications of a stroke.  His son attributes his death to his bad habits, including smoking.  What caught my attention was the last statement by his son in this CNN quote:

“He did cut back on energy drinks, quite a bit from what he’d usually do,” Josh said, “but [doctors] have determined that smoking was the cause of this, and that was always his biggest habit. He had changed a lot of his habits but just could never kick the smoking. He started working with that electronic cigarette but, not used to it, he didn’t know how to charge it. He just kept smoking.”