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Benefits of timely basal insulin control in patients with type 2 diabetes

Journal of Diabetes and its Complications, Volume 29, Issue 2, March 2015, Pages 295 - 301

Summary

Worldwide, both underdiagnosis and undertreatment leave many patients exposed to long periods of hyperglycemia and contribute to irreversible diabetes complications. Early glucose control reduces the risk of both macrovascular and microvascular complications, while tight control late in diabetes has little or no macrovascular benefit. Insulin therapy offers the most potent antihyperglycemic effect of all diabetes agents, and has a unique ability to induce diabetes remission when used to normalize glycemia in newly diagnosed patients. When used as a second-line therapy, basal insulin is more likely to safely and durably maintain A1C levels ≤ 7% than when insulin treatment is delayed. The use of basal insulin analogs is associated with a reduced risk of hypoglycemia and weight gain compared to NPH insulin and pre-mixed insulin. Patient self-titration algorithms can improve glucose control while decreasing the burden on office staff. Finally, recent data suggest that addition of incretin agents to basal insulin may improve glycemic control with very little, if any increased risk of hypoglycemia or weight gain.

Keywords: Insulin treatment, Glycemic goals, Insulin titration, Basal insulin, Insulin initiation, type 2 diabetes mellitus.

Footnotes

Tulane University Health Sciences Center, New Orleans, LA

Corresponding author at: Tulane University Health Sciences Center, 1430 Tulane Avenue, SL 53, New Orleans, LA 70112. Tel.: + 1 504 988 4026; fax: + 1 504 988 6271.

Conflict of Interest statements: Dr. Fonseca has received honoraria for consulting and lectures from GlaxoSmithKline, Takeda, Novo Nordisk, Sanofi, Eli Lilly, Pamlab, Astra-Zeneca, Abbott, Bristol-Myers Squibb, Merck, and Boehringer Ingelheim. Dr. Lovre has nothing to disclose.

Grant support: Sanofi.