Intensification of Insulin Therapy in Patients with Type 2 Diabetes Mellitus: an Algorithm for Basal-bolus Therapy

Overview

Journal Ann Med

Publisher Informa Healthcare

Specialty General Medicine

Date 2012 Jul 25

PMID 22822902

Citations 12

Authors

Martin J Abrahamson

Anne Peters

Affiliations

Soon will be listed here.

Abstract

The incidence of diabetes mellitus is projected to continue to increase worldwide over the next 20 years leading to increased costs in the management of the disease and its associated co-morbidities. Insulin replacement is one of many treatment options that can help to bring about near normoglycemia in the patient with type 2 diabetes mellitus (T2DM). Glycemic control as close to normoglycemia as possible can help to reduce the risk of microvascular and macrovascular complications, yet less than one-half of patients with T2DM achieve glycemic targets as recommended by practice guidelines. The purpose of this review is to provide guidance to primary care physicians for the initiation and intensification of basal-bolus insulin therapy in patients with T2DM. Two treatment algorithms that can be both patient- and physician-driven are proposed: a stepwise approach and a multiple daily injections approach. Evidence shaping the two approaches will be discussed alongside management issues that surround the patient treated with insulin: hypoglycemia, weight gain, patient education, and quality of life.

Citing Articles

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Impact of a Weekly Glucagon-Like Peptide 1 Receptor Agonist, Albiglutide, on Glycemic Control and on Reducing Prandial Insulin Use in Type 2 Diabetes Inadequately Controlled on Multiple Insulin Therapy: A Randomized Trial.

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Use of Insulin Glargine 100 U/mL for the Treatment of Type 2 Diabetes Mellitus in East Asians: A Review.

Hirose T, Chen C, Ahn K, Kiljanski J Diabetes Ther. 2019; 10(3):805-833.

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References

Akram K, Pedersen-Bjergaard U, Borch-Johnsen K, Thorsteinsson B . Frequency and risk factors of severe hypoglycemia in insulin-treated type 2 diabetes: a literature survey. J Diabetes Complications. 2006; 20(6):402-8. DOI: 10.1016/j.jdiacomp.2005.08.005. View

Nathan D, Buse J, Davidson M, Ferrannini E, Holman R, Sherwin R . Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2008; 32(1):193-203. PMC: 2606813. DOI: 10.2337/dc08-9025. View

Turner R, Cull C, Frighi V, Holman R . Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA. 1999; 281(21):2005-12. DOI: 10.1001/jama.281.21.2005. View

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

Anderson Jr J, Brunelle R, Keohane P, Koivisto V, Trautmann M, Vignati L . Mealtime treatment with insulin analog improves postprandial hyperglycemia and hypoglycemia in patients with non-insulin-dependent diabetes mellitus. Multicenter Insulin Lispro Study Group. Arch Intern Med. 1997; 157(11):1249-55. View

Palumbo P . The case for insulin treatment early in type 2 diabetes. Cleve Clin J Med. 2004; 71(5):385-6, 391-2, 394 passim. DOI: 10.3949/ccjm.71.5.385. View

Fritsche A, Larbig M, Owens D, Haring H . Comparison between a basal-bolus and a premixed insulin regimen in individuals with type 2 diabetes-results of the GINGER study. Diabetes Obes Metab. 2010; 12(2):115-23. DOI: 10.1111/j.1463-1326.2009.01165.x. View

Yki-Jarvinen H, Kauppinen-Makelin R, Tiikkainen M, Vahatalo M, Virtamo H, Nikkila K . Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study. Diabetologia. 2006; 49(3):442-51. DOI: 10.1007/s00125-005-0132-0. View

Meneghini L, Mersebach H, Kumar S, Svendsen A, Hermansen K . Comparison of 2 intensification regimens with rapid-acting insulin aspart in type 2 diabetes mellitus inadequately controlled by once-daily insulin detemir and oral antidiabetes drugs: the step-wise randomized study. Endocr Pract. 2011; 17(5):727-36. DOI: 10.4158/EP10367.OR. View

10.

Bergenstal R, Johnson M, Powers M, Wynne A, Vlajnic A, Hollander P . Adjust to target in type 2 diabetes: comparison of a simple algorithm with carbohydrate counting for adjustment of mealtime insulin glulisine. Diabetes Care. 2008; 31(7):1305-10. PMC: 2453649. DOI: 10.2337/dc07-2137. View

11.

Plockinger U, Topuz M, Riese B, Reuter T . Risk of exercise-induced hypoglycaemia in patients with type 2 diabetes on intensive insulin therapy: comparison of insulin glargine with NPH insulin as basal insulin supplement. Diabetes Res Clin Pract. 2008; 81(3):290-5. DOI: 10.1016/j.diabres.2008.04.018. View

12.

Rodbard H, Blonde L, Braithwaite S, Brett E, Cobin R, Handelsman Y . American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007; 13 Suppl 1:1-68. DOI: 10.4158/EP.13.S1.1. View

13.

Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S . Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995; 28(2):103-17. DOI: 10.1016/0168-8227(95)01064-k. View

14.

Davis N, Wylie-Rosett J . Death to carbohydrate counting?. Diabetes Care. 2008; 31(7):1467-8. PMC: 2453662. DOI: 10.2337/dc08-0807. View

15.

Mayfield J, White R . Insulin therapy for type 2 diabetes: rescue, augmentation, and replacement of beta-cell function. Am Fam Physician. 2004; 70(3):489-500. View

16.

Riddle M . Glycemic management of type 2 diabetes: an emerging strategy with oral agents, insulins, and combinations. Endocrinol Metab Clin North Am. 2005; 34(1):77-98. DOI: 10.1016/j.ecl.2004.12.002. View

17.

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

18.

Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch I, Inzucchi S, Genuth S . Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med. 2011; 154(8):554-9. DOI: 10.7326/0003-4819-154-8-201104190-00007. View

19.

Anderson Jr J, Brunelle R, Koivisto V, Trautmann M, Vignati L, DiMarchi R . Improved mealtime treatment of diabetes mellitus using an insulin analogue. Multicenter Insulin Lispro Study Group. Clin Ther. 1997; 19(1):62-72. DOI: 10.1016/s0149-2918(97)80073-2. View

20.

Lowe J, Linjawi S, Mensch M, JAMES K, Attia J . Flexible eating and flexible insulin dosing in patients with diabetes: Results of an intensive self-management course. Diabetes Res Clin Pract. 2008; 80(3):439-43. DOI: 10.1016/j.diabres.2008.02.003. View