Improving Glycemic Control with Pre-Mixed Insulin

Authors

• Gilbert-Roy Kamoga, MD, FACP, CPE, Thomas Jefferson UniversityFollow

Document Type

Presentation

Publication Date

4-9-2026

Comments

Presentation: 44:47

Abstract

Poor glycemic control remains a major challenge among underserved populations with type 2 diabetes mellitus (T2DM), particularly those facing language barriers, low health literacy, and complex treatment regimens. The Marshallese community in Northwest Arkansas has a disproportionately high prevalence of insulin-dependent T2DM, suboptimal adherence to multi-injection insulin regimens, and persistently elevated hemoglobin A1c (HbA1c) levels. At an internal medicine residency clinic serving a large Marshallese population, over 75% of insulin-dependent patients had HbA1c >9%. High no-show rates and low adherence to basal-bolus insulin regimens contributed to poor outcomes. A prospective pilot quality improvement (QI) project to implement a simplified twice-daily premixed insulin (70/30) regimen, supported by culturally tailored education and follow-up, was conducted among the Marshallese population. Adult Marshallese patients with insulin-dependent T2DM and HbA1c >9% were enrolled and followed biweekly for 12 weeks. Outcome measures included changes in HbA1c and average blood glucose. Process measures included adherence to follow-up and completion of glucose logs. Hypoglycemia served as the balancing measure. Key interventions included a standardized insulin initiation and titration protocol, Community Health Worker (CHW)-led culturally and linguistically appropriate education, structured telehealth and in-person follow-up, and multidisciplinary care coordination. Thirty-one patients completed the intervention. Among participants with available 3-month data, all showed improvement in HbA1c, with the majority achieving HbA1c < 9%. Mean blood glucose values trended downward over time. Only one asymptomatic hypoglycemic episode was observed. Telehealth visits were associated with higher no-show rates than in-person visits. Blood glucose log completion remained inconsistent. A simplified premixed insulin regimen, combined with CHW-supported multidisciplinary care, led to clinically meaningful improvements in glycemic control with minimal hypoglycemia in a high-risk, underserved population. This approach represents a feasible, patient-centered strategy for improving diabetes outcomes in culturally and linguistically diverse communities.

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Language

English