Psychological Considerations During Insulin Product Changes

Understanding the Patients’ Psychological Impact

When patients need to change insulin products due to discontinuations, they often experience psychological burdens. This transition can trigger anxiety, fear, and resistance that may compromise treatment adherence and adequate glycemic control.^1,2 Understanding this impact and having strategies to address patient concerns is essential for successful transitions.

While patients typically find changing insulin regimens more acceptable than starting insulin therapy for the first time, some psychological barriers may remain³:

• Concerns about disruption to daily routines
• Burden of managing potentially more frequent injections
• Anxiety about potential weight gain
• Fear of hypoglycemia, affecting approximately one in seven diabetes patients¹

In general, these barriers may influence patients' willingness to modify their insulin regimen, even when changes could improve glycemic control.³

As healthcare professionals, recognizing these psychological factors is the first step toward facilitating smoother transitions and maintaining treatment adherence during insulin product changes.

Patient Support Considerations During Transition Periods

Successfully navigating insulin product changes requires a patient centered approach that addresses the psychological aspects of transition. People living with diabetes experience an emotional and physical burden associated with hypoglycemia,^1,4 which may intensify during product transitions due to their lack of confidence in managing new dosing schedules and titrating new insulin regimens. Healthcare professionals should recognize that fear of hypoglycemia may have an impact on a patient's willingness to accept new insulin regimens and adhere to treatment recommendations.

Need time to practice addressing your patients' concerns about insulin and fear of hypoglycemia? DiaTalk gives you that opportunity. This productneutral online training lets you rehearse conversations with type 2 diabetes patients at your own pace. Access the training directly below or open it in a separate window via the link.

Considerations When Selecting Alternative Basal Insulins

When selecting alternative basal insulins following the discontinuation of a product, multiple factors should be considered. A key factor influencing confidence in the choice of basal insulin is its potentially reduced risk of hypoglycemia.^6,7

A basal insulin should aim to have a low risk of hypoglycemia while providing consistent, predictable effects from day to day.^7-9 Reducing variability in insulin response is key to ensuring effective and safe diabetes management for patients,⁹ especially during transitions between products.

The latest EASD/ADA guidelines note that long-acting basal insulins are associated with reduced hypoglycemia risk compared to earlier-generation basal insulins and offer flexible dosing times.¹⁰ This flexibility can be valuable when transitioning patients, as it may help accommodate their existing routines and preferences.

Real-World Evidence Supporting Successful Switching

Real-world studies provide valuable insights into the outcomes of switching between insulin products. Second-generation basal insulins have been associated with similar glucose control, but a lower risk of hypoglycemia compared to first-generation basal insulins in people switching insulin therapy.¹¹ This suggests that despite the challenges of transitioning, appropriate switches may be associated with certain hypoglycemic benefits.

Real-world evidence also suggests that lowering the risk of hypoglycemia may allow for dose titration and better glycemic control, as reported by multiple studies.^5,7,11

Notably, barriers to insulin initiation, such as fear of hypoglycemia and body weight gain, can be minimized with the concomitant use of GLP-1 receptor agonists and second-generation basal insulins.¹¹ This combination approach may be valuable when transitioning patients who express significant anxiety about changing insulin products.

Conclusion