Insulin Therapy for Diabetes: Is the Future Now?

On a recent consultation for the inpatient endocrine service, we were asked to see a 38-year-old woman with a 22-year history of type 1 diabetes. Her admission had nothing to do with diabetes, but she was on dialysis for end-stage renal disease, and she was blind from retinopathy. She was receiving a fixed-mixed ratio of twice-daily insulin but noted that for most of her life with diabetes she was prescribed once-daily insulin.

Are these stories ever going to go away, or will they continue until there is a “cure”? My concern is that this all-too-common scenario will not disappear for many years.

At a recent meeting with more than 100 endocrinology fellows in the audience, I asked the group how many of them received formal training in the use of insulin therapy. To my surprise, fewer than 10 raised their hands. Several years ago, another endocrine fellow told me that during his 2-year fellowship, he did not manage even one patient with diabetes. These diabetes experts of the future are not receiving the critical training or learning about the “clinical pearls” they must know in order to make the best use of insulin to help patients achieve HbA_1c targets while minimizing the risk for hypoglycemia.

I have thought for many years that most endocrinologists do not really learn how to manage insulin therapy until their formal training …