Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

We all like having choices. But sometimes, choices can be overwhelming. Marketing research shows that when faced with many choices, people can become frustrated or indecisive.

Choices can be confusing in health care, too—especially when it comes to choosing a treatment for an illness like diabetes. But when it comes to your health, you don't want to put off making important decisions.

That's why my agency, the Agency for Healthcare Research and Quality (AHRQ), develops consumer-friendly guides to help patients and their families better understand their treatment choices for diabetes and other health problems. The guides alert you to the benefits and risks of current treatments based on a review of the latest studies. Having this information can help you work with your doctor to make the best treatment decisions for you.

For instance, one of AHRQ's guides compares the benefits, side effects, and costs of a new type of premixed insulin with other kinds of insulin and pills for diabetes.

If you have type 2 diabetes, your body does not make enough insulin or your body does not use insulin as well as it should. Sugar builds up in the blood because the body cannot use it without the help of insulin. If blood sugar stays high for a long time, you have a higher risk of heart attacks, strokes, blindness, kidney damage, and other serious problems. Keeping your blood sugar at a good level can lower your chance of these complications.

Some people take pills for their type 2 diabetes and do not need insulin. But 1 in every 3 people with type 2 diabetes takes insulin. People with type 2 diabetes have many kinds of insulin to choose from and many different ways to take it.

If you need insulin to control your diabetes, you may be confused by the different types that are available. The kind you need depends on your activity level, eating habits, and how your body responds to insulin. AHRQ's diabetes guide describes the different types of insulin:

  • Insulin that lasts all day. There are two kinds of insulin that control blood sugar all through the day: intermediate-acting and long-acting insulin. Both provide constant, low levels of insulin and usually require that you take one or two shots a day.
  • Insulin taken only at meal times. Over time, one kind of insulin may not be enough to control your blood sugar. You may also need to take insulin at meal times. There are two kinds: fast-acting and short-acting insulin. Both kinds work quickly and last for a short period of time. This can mean taking two or more shots a day.
  • Premixed insulin for all day and meals. You may also take a combination of both kinds of insulin. Premixed insulin gives you fast-acting coverage for a meal plus longer coverage for other times of the day. If you take premixed insulin, you may need fewer daily shots.

Research studies have compared newer premixed insulin with other diabetes medicines. AHRQ's guide, which is based on those studies, explains the differences among the types of insulin. Having this information can help you and your doctor match your needs with the kind of insulin that might work best for you. For example, newer premixed insulin is better than diabetes pills at lowering blood sugar. However, this type of insulin is more likely to cause very low blood sugar and cause more weight gain compared with diabetes pills. (AHRQ also has a guide for adults who take pills for type 2 diabetes.)

Compared with long-acting insulin, newer premixed insulin can lower your blood sugar better over longer periods (2 to 3 months) and after meals. But long-acting insulin is better at lowering blood sugar before eating and has fewer side effects.

To develop the guide, scientists used a type of research to compare the effectiveness of premixed insulin for type 2 diabetes. Comparative effectiveness research focuses on a specific health condition and identifies the pros and cons of different treatments so you can decide what's right for you.

These research findings do not make your choice for you. That decision is always left to you and your doctor. But you can make an informed decision when you know the benefits and risks of treatments and can decide on the right balance for you.

Having a lot of information doesn't always help you make the best decision. But having information that spells out how different treatments work can go a long way in helping you make the best decision for you.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

Agency for Healthcare Research and Quality

Premixed Insulin for Type 2 Diabetes: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=125

Effective Health Care Program
http://effectivehealthcare.ahrq.gov/index.cfm

Medicines for Type 2 Diabetes: A Review of the Research for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=721

Current as of February 2010
Internet Citation: Comparing Diabetes Drugs. February 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/020210.html