TY - JOUR
T1 - Intensifying insulin therapy
T2 - What options are available to patients with type 2 diabetes?
AU - Meneghini, Luigi F.
N1 - Funding Information:
Funding: The publication of this article was funded by Novo Nordisk Inc .
PY - 2013/9
Y1 - 2013/9
N2 - 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.
AB - 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.
KW - Basal insulin intensification
KW - Basal plus insulin therapy
KW - Basal-bolus therapy hypoglycemia
UR - http://www.scopus.com/inward/record.url?scp=84882253914&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84882253914&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2013.06.011
DO - 10.1016/j.amjmed.2013.06.011
M3 - Article
C2 - 23953077
AN - SCOPUS:84882253914
SN - 0002-9343
VL - 126
SP - S28-S37
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 9 SUPPL.1
ER -