Insulin@100: Insulin initiation and intensification

With world-wide prevalence of diabetes forecast to hit 700 million in the next 25 years, the need for effective insulin initiation and intensification has never been more pressing. Yet despite remarkable therapeutic advances since insulin’s discovery in 1921, particularly over the last 20 years, the last two decades have seen achievement of glycaemic targets decline from almost 70% to 63.8%. 

In the second of the EASD e-Learning platforms Insulin@100 series, Dr Hermelinda Pedrosa, Co-ordinator of the Research Centre Endocrinology Unit in Brasilia’s Health Secretariat, looks at why this might be and what we need to do to improve insulin initiation and intensification. The impassioned presentation that follows encompasses treatment inertia, hypoglycaemia, overbasalisation and, critically, resources.

While pointing to the promise of new basal insulins and innovation in monitoring technologies, she urges us not to lose sight of cost, especially in countries that can’t afford to make some of these innovations available within public health systems. Crucial to moving forward, she insists, is education. And move forward we must, she says; otherwise: “If you don’t deal with inertia, it will deal with you.”

Click here to view Dr Pedrosa’s presentation, Insulin initiation and intensification.

For more on therapeutic inertia, visit our course ‘Therapeutic inertia’.