Basal insulin supplementation in type 2 diabetes; refining the tactics

Am J Med. 2004 Feb 2;116 Suppl 3A:10S-16S. doi: 10.1016/j.amjmed.2003.12.004.

Abstract

The burden of type 2 diabetes mellitus will become even greater in coming decades as more young people present with the disease and patients live longer with the devastating complications of chronic hyperglycemia. Conventional and largely ineffectual treatment strategies consisting of lifestyle measures and long-term oral therapy are being challenged by studies showing that the early addition of insulin to oral agents can significantly improve glycemic control in patients with type 2 diabetes. Further, 2 recent randomized, controlled trials support the clinical utility of supplementing oral pharmacotherapy with once-daily insulin glargine to achieve and maintain target glycosylated hemoglobin levels < or =7%. This simple treat-to-target strategy may be readily adopted in general practice through a widely translatable algorithm moving from oral pharmacotherapy to early addition of basal insulin glargine if glycemic targets are not met. The once-daily flexible dosing of insulin glargine and its smooth, flat profile, associated with fewer episodes of nocturnal hypoglycemia, make it among the safest and most practical tools to date for transforming the paradigm of type 2 diabetes management.

Publication types

  • Review

MeSH terms

  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hyperglycemia / prevention & control
  • Hypoglycemic Agents / administration & dosage*
  • Insulin / administration & dosage*
  • Insulin / analogs & derivatives*
  • Insulin Glargine
  • Insulin, Long-Acting

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • Insulin, Long-Acting
  • Insulin Glargine