Intensifying insulin therapy: What options are available to patients with type 2 diabetes?

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

The progressive nature of type 2 diabetes (T2D) requires practitioners to periodically evaluate patients and intensify therapy when glycemic targets become unattainable with their current treatment regimen. Traditional first- and second-line antidiabetic agents such as metformin and the sulfonylureas do not prevent the characteristic decline in beta-cell function associated with T2D; insulin replacement therapy can therefore quickly become a necessity in some patients. Basal insulin initiation provides an excellent platform to which rapid-acting prandial insulin doses can easily be added, potentially in a stepwise manner, as disease progresses. Premix insulin regimens are another effective intensification option following basal insulin initiation, but are most effective in insulin-naïve patients. The use of insulin in combination with modern T2D agents, such as the incretin-based therapies, has the potential to improve glycemic control while limiting insulin-associated weight gain and hypoglycemia. Further clinical data and approval are required before practitioners can fully endorse this novel approach.

Original languageEnglish (US)
Pages (from-to)S28-S37
JournalAmerican Journal of Medicine
Volume126
Issue number9 SUPPL.1
DOIs
StatePublished - Sep 1 2013

Keywords

  • Basal insulin intensification
  • Basal plus insulin therapy
  • Basal-bolus therapy hypoglycemia

ASJC Scopus subject areas

  • Medicine(all)

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