Despite significant advancements in diabetes medication and technology, challenges within insulin management remain for both patients and the pharmacists or specialists counseling them. While significant progress has been made in continuous glucose monitoring (CGM) technology, as well as life-saving glucagon-like peptide-1 (GLP-1) drugs, researchers and providers alike have yet to fully eradicate hypoglycemia among patients with diabetes.
“I think this puts into perspective the challenges with insulin and how there’s still more to be done,” Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, director of education and training in diabetes at Cleveland Clinic, told Drug Topics. “As much as CGM has been incredible, and it has reduced hypoglycemia and made people aware, it has not eliminated hypoglycemia.”
Isaacs discussed advancements in CGM and GLP-1 medications, explaining how they may impact insulin delivery going forward. | image credit: Fabián Montaño / stock.adobe.com
Isaacs recently met with Drug Topics to discuss the challenges and advancements in insulin delivery management. From the pharmacists’ evolving role to emerging therapies that the pharmaceutical market has never seen before, learn about the current advancements in the diabetes and insulin spaces from a certified diabetes expert and educator.
READ MORE: Insulin Advancements Led to Safer Surgeries, Shorter Hospital Stays
Drug Topics: How has the administration of insulin management been impacted by medical advancements in things like CGM and GLP-1 medications?
Diana Isaacs: It’s really interesting. GLP-1 medications have taken the world by storm. There are so many people using them, and they really have tremendous benefits in terms of glucose lowering and decreasing weight. Many people have been able to come off of insulin through adding these medications. I think they’ve definitely made a big impact in this space, and they will continue to do that. Even with the GLP-1s, there are many, many people that still need insulin to be able to reach their glucose levels. Now this is something, we’ll see what happens over time, because recently at the ADA Scientific Sessions, there are other agents in development that have even more glucose lowering and weight loss. Potentially, more and more people will be able to come off of insulin. But I think that there are still so many that developed type 2 diabetes (T2D) at a young age that just are going to really need insulin. Then, of course, all the people with type 1 diabetes, which type 1 is actually on the rise. All the people with type 1 have to have insulin.
Continuous glucose monitoring has, for sure, been a game changer. We have seen that explode, really kind of side by side with the GLP-1 medications to the point where now anyone on insulin, any type of insulin, even just a once-a-day, long-acting insulin, typically now has access to CGM. They will have insurance coverage, and that has helped tremendously to be able to adjust insulin doses.
One of the fascinating things is that when you look at the guidelines for time in range with CGM, the guidelines recommend 70% or more in the target range of 70 to 180 with less than 4% of the time below 70. When I hear that we are okay with up to 4% of the time below 70, which to put that in perspective, 1% of time is about 15 minutes. That is up to almost an hour a day that we’re like, ‘Hey, it’s okay you’re below 70.’ So why are we okay with that? Well, it turns out, it’s really challenging to manage glucose levels with insulin and not have any hypoglycemia and still overall achieve your goals.
I think this puts into perspective the challenges with insulin and how there’s still more to be done. As much as CGM has been incredible, and it has reduced hypoglycemia and made people aware, where they can look at their CGM, or they can get an alert and know, ‘Hey, I need to take some fast-acting carbohydrates.’ But it has not eliminated hypoglycemia.
READ MORE: Insulin Management Resource Center
Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our free Drug Topics newsletter.