Most patients with type 2 diabetes evenutally require insulin to manage hyperglycemia and insulin intensification is the norm as beta cell function continues to decline. Prescribing insulin effectively is nuanced medicine. These 5 slides look at signs your patient is ready for insulin, and research on reduced risk of nocturnal hypoglycemia, GLP-1 agonists with basal insulin, obesity and response to biphasic insulin 50/50, and the pros and cons of premixed vs multidose insulin.
In patients with type 2 diabetes, progressive beta cell failure leads to near universal need for insulin replacement therapy. Oral antidiabetic agents may stall insulin initiation, but the signs that a patient is ready are clear. Details here.
In patients with type 2 diabetes who require basal and mealtime insulin, glycemic control achieved in the multinational EDITION-1 study was similar for investigational U300 glargine (Gla-300; Sanofi) and U100 glargine (Gla-100; Lantus [Sanofi]).Study details here.
When compared specifically to basal-bolus insulin, the combination of basal insulin and GLP-1 agonists led to a greater reduction in A1c, although the proportion of patients achieving A1c goals was similar. The combination of GLP-1 + basal insulin showed no significant differences in the risk of hypoglycemia when compared to other treatments; however, when specifically compared to basal-bolus insulin the GLP-1/insulin combination showed a significantly lower risk of hypoglycemia. Details here.
Hyperglycemia in patients taking insulin is difficult to manage. Treatment intensification often targets postprandial glucose excursions and premixed biphasic insulin formulations (30/70, 25/75) are used. Independent predictors of decrease in A1c using premixed insulin 50/50 were BMI =/> 30; =/> 9 months of intensified treatment, and baseline A1c. Details here.
Twice-daily analog premixed insulin (biphasic insulin aspart 30) was shown superior to once-daily basal insulin (glargine) in the INITIATE Trial. A1C was 0.5% lower with 2 doses of premixed compared to intensifying the once-daily dose of basal insulin. Difference is attributed to lower postprandial glucose values at breakfast and dinner achieved with the short-acting component of the premixed insulin.Details here.
