The pharmacist's role in maintaining adherence to insulin therapy in type 2 diabetes mellitus.

OBJECTIVE

To provide pharmacists with recommendations on how to help patients with type 2 diabetes mellitus (T2DM) achieve optimal glycemic control with insulin therapy by addressing common barriers to insulin and to improve adherence to therapy.

DATA SOURCES

Articles identified from PubMed searches using the terms diabetes, insulin, monitoring, pharmacist, counseling, intensive antidiabetic therapy, glycemic control, adherence, and compliance in various combinations.

DATA EXTRACTION

Studies selected provided information on glycemic control, patient counseling to support glycemic control, prevention of diabetes complications, barriers to initiating insulin treatment, and patient adherence to antidiabetic therapies.

DATA SYNTHESIS

An abundance of data support achieving glycemic control for prevention of diabetes-associated complications. However, most patients with diabetes do not receive optimal therapy to attain and/or maintain glycemic goals. Insulin regimens, such as basal-insulin therapy, added to oral agents or basal-prandial approaches, are effective, but often are delayed or inadequately advanced. Additionally, some patients may not obtain maximal therapeutic benefit because of poor adherence to their treatment plans. Since patients may have more frequent or easy access to pharmacists in community, clinic, and hospital settings, pharmacists are in a position to identify adherence issues and barriers to insulin use and, through education and counseling, help their patients with T2DM optimize the use of insulin therapy.

CONCLUSION

Pharmacists can play a pivotal role in improving adherence to insulin therapy and support the efforts of other members of the health care team in helping patients with T2DM attain and maintain glycemic goals.