Journal
AMERICAN JOURNAL OF MEDICINE
Volume 126, Issue 9, Pages S28-S37Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2013.06.011
Keywords
Basal insulin intensification; Basal plus insulin therapy; Basal-bolus therapy; hypoglycemia
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Funding
- Novo Nordisk Inc.
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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-naive 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. (C) 2013 Elsevier Inc. All rights reserved.
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