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In the US, approximately 22 million adults are living with diabetes; of these, 90–95% are classified as having type 2 diabetes (T2DM), a progressive disease in which beta cell function declines based on the duration of the disease and level of glycemic control. The American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) both recognize that achieving and maintaining the patient’s glycemic goals are essential for the prevention, or delay in progression, of chronic complications associated with diabetes. However, about half of US adults are not meeting their glycemic goals. Based on the most recent data, 50% of adults with diabetes are taking only oral medications for glycemic control; at least 30% are using insulin, either in combination with oral therapy or as monotherapy. With the rising rates of obesity and T2DM, insulin is emerging as a “sooner rather than later” treatment option.
Why more insulin products? For the past several decades, pharmaceutical companies have attempted to develop insulin formulations that kinetically mimic endogenous insulin secretion. An ideal bolus insulin should have a rapid onset and short duration of action, while an ideal basal insulin would produce smooth or constant plasma levels over a prolonged duration. Although insulin products have improved over the years, there is no product that mimics physiologic insulin secretion exactly.
In 2015, the FDA approved 3 new concentrated insulin products (lispro U-200, glargine U-300, degludec U-200), and in 2016 a new prefilled delivery device for regular U-500 insulin was approved. Compared with neutral protamine Hagedorn (NPH) insulin, the new long-acting products more closely resemble an ideal basal insulin.
Insulin is considered a high-alert medication by the Institute for Safe Medication Practices in both the inpatient and outpatient settings. It is fraught with dosing, dispensing, and administration errors. The emergence of the concentrated insulin products challenges providers to educate both patients and other healthcare professionals about the differences, benefits, practical use, safety, and efficacy of these agents.
This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.
Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.
The Rx Consultant is a publication of Continuing Education Network, Inc.
ACPE Universal Activity Number: 0428-0000-16-008-H01-P
Chief Editor and CE Administrator
Terry M. Baker, PharmD
Tracy Farnen, PharmD
James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Associate Clinical Professor
Richard Ron Finley, B.S. Pharm.,R.Ph.
Consult Pharmacist Aging and Adult Health Services
Julio R. Lopez, PharmD, FCSHP
Adjunct Clinical Professor
Assistant Clinical Professor
Visiting Associate Professor and Lecturer
Pamela Mausner, MD
Helen Berlie, Pharm.D. CDE, BCACP
Ambulatory Care Specialist - Diabetes
Senior Editorial Advisor
Gerard Hatheway, PharmD, PhD
Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD
Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners
Meuleman, RN, C, MS
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