Insulin and value-added therapy

Insulin Therapy

We are all familiar with the abbreviation VAT, which stands for value-added tax. Most readers take VAT as an integral, necessary part of life and understand the benefits that accrue from it.

Insulin therapy too is acknowledged as an essential aspect of diabetes management, with unquestionable benefits. In spite of great strides in the manufacture, presentation and quality of this molecule, however, we have not achieved commensurable improvement in glycemic control. Data from across the world reports sub optimal control of persons started on insulin therapy. The best of randomized controlled trials and observational studies are unable to achieve target glycemic levels in all enrolled subjects. This happens in spite of aggressive treat to-target protocols used.

What implication does this have for clinical practice? One suggestion, expounded upon in this article, is the need for value added therapy (VAT), in addition to insulin therapy.

• References

• 1 Nadeau DA. Physiologic and weight-focused treatment strategies for managing type 2 diabetes mellitus: The metformin, glucagon-like peptide-1 receptor agonist, and insulin (MGI) approach. Postgrad Med 2013; 125: 112-126
• 2 Cohen ND, Audehm R, Pretorius E, Kaye J, Chapman LH, Colagiuri S. The rationale for combining GLP-1 receptor agonists with basal insulin. Med J Aust 2013; 199: 246-249
• 3 Kalra S, Unnikrishnan AG, Baruah M, Kalra B. Degludec insulin: A novel basal insulin. Indian J Endocrinol Metab 2011; 15: S12-S16
• 4 Kalra S, Kalra B, Batra P. Patient motivation for insulin/injectable therapy: The Karnal model. Int J Clin Cases Invest 2010; 1: 11-15