The IMPERIAL study: physicians' perceptions regarding intensification of insulin therapy
Sanjay Kalra1, Bharti Kalra1 & Satish Kumar2
The Indian Medical Practitioners Expressions Regarding Drug Interventions in All Aspects of Metabolic Syndrome (IMPERIAL) study-5 was planned to assess physicians perceptions regarding the relative importance and effectiveness of various methods used to upgrade or intensify insulin therapy in patients not achieving glycemic control.
Seventy-four diabetologists/endocrinologists, with clinical experience of 20.25±5.0 years, attending a conference, were requested to complete a pretested, structured five point Likert scale questionnaire which listed 11 methods of insulin intensification. Intensification of therapy was defined as a change in insulin formulation, regimen, frequency or dosage, or addition of other therapeutic modalities, with a view to improving glycemic control.
The most important/effective methods of insulin intensification were increasing insulin dose (mean±S.D. score 3.58±0.40), increasing the number of doses of insulin (intensifying the regime) (3.43±0.36), and changing to insulin analogue (3.28±0.32). Other effective methods were increasing the insulin-meal time gap (2.63±0.20), addition of a DPP-4 inhibitor (2.61±0.20), improving insulin technique (2.57±0.31) and using modern delivery devices (2.55±0.20). Less effective methods of intensification were thought to be addition of a sensitizer (2.4±0.21). Change of insulin brand (2.26±0.42), and adding a GLP-1 agonist (1.72±0.18) or anxiolytic/anti-depressant (1.50±0.31).
Statistical significance was reached for the first three methods versus the rest (P<0.05).
This survey of experienced physicians reveals the preferred methods of insulin intensification in patients of type 2 diabetes. Increasing dose or frequency of insulin and shifting to modern analogues rank as the most effective methods of insulin intensification.