A review of insulin-treated diabetes finds that, despite modern insulin analogs and diabetes tech (CGM, automated insulin delivery, smart pens), most patients still do not achieve glycemic targets—especially those needing prandial insulin—driving ongoing complications and costs.

Why It Matters To Your Practice

• Persistent suboptimal glycemic control means preventable microvascular and macrovascular risk continues even in “treated” patients.

• Patients requiring prandial insulin represent a high-need group where day-to-day regimen complexity can undermine outcomes.

• Diabetes-related complications increase utilization and total cost of care, making missed targets a clinical and operational problem.

Clinical Benefits

• Identifying barriers (e.g., adherence challenges, regimen complexity, postprandial control gaps) can guide more effective insulin intensification and follow-up.

• Leveraging CGM and insulin delivery tools can support more timely dose adjustments and patient self-management.

• Considering alternative prandial strategies—including inhaled insulin where appropriate—may help some patients achieve safer, more practical post-meal control.

Managing Risks

• Insulin intensification can raise hypoglycemia risk; mitigation requires patient education, CGM-informed adjustments, and individualized targets.

• Technology can add burden (training, alarms, data overload); ensure workflow support and realistic expectations.

• Any shift in prandial approach (including inhaled options) requires careful patient selection, counseling, and monitoring for tolerability and safety.

The Bottom Line

• Even with today’s insulin and devices, glycemic targets are commonly missed in insulin-treated diabetes, with prandial insulin needs marking a key unmet therapeutic gap.

• For NPs and PAs, the opportunity is systematic: uncover barriers, simplify where possible, use CGM data to act faster, and match prandial strategies to patient realities.