Speaker: Date: Topic
Richard S, Beaser, MD
Jun 24, 2015
Treatment of Type 2 Diabetes: When Insulin Replacement Therapy is Needed
Responsibility for Content
The PowerPoint presentation, Take-Away points, and Article links were sent by Medical Library Services and the CME Committee.
Diane E. Young, Information Specialist
Take-Away Points of the Presentation
For insulin treatment of type 2 diabetes, when basal insulin alone is not providing adequate glycemia control, options for therapeutic advancement include adding a GLP-1 receptor agonist, changing to fixed mixture insulin, adding bolus insulin before one meal (“basal plus”) or going to a full basal/bolus program with basal insulin plus bolus insulin doses before each meal.
A clinical estimation of the predominance of the various underlying pathophysiologic mechanisms for hyperglycemia in any give patient is useful in deciding which insulin advancement program would be best. In making that determination, use of A1C and glycemic patterns can be helpful. Further, consider patient comorbidities, self-care abilities, and perspectives in designing subsequent treatment advancement.
All patients should have potential access to all current insulin replacement treatment designs and equipment. Each clinician treating people with diabetes who need, or could potentially need, insulin replacement treatments should be aware of the spectrum of, and indications for, treatments now available, from basal insulin only to insulin pumps and continuous glucose monitors. All such clinicians should, if they are not able to provide this spectrum of care directly in their practice, at least understand that these treatments exists, why they might be indicated, and how to recognize the presence of problems with therapy. They should plan a process by which they can coordinate support of these treatments with area specialty centers.
Links to Articles Cited in the Presentation
- 1) ADA glycemic targets. Diabetes Care 2015;38 Suppl:S33-40.
- 2) AACE comprehensive diabetes management algorithm 2013 consensus statement. Endocr Pract 2013;19(S
- 3) Effects of early intro of intensive insulin therapy on the clinical course in non-obese NIDDM pat
- 4) Basal insulin and cardiovasc and other outcomes in dysglycemia. NEJM 2012;367:319-28.
- 5) The burden of treatment failure in type 2 diabetes. Diabetes Care 2004;27:1535-40.
- 6) Management of hyperglycemnia in type 2 diabetes: position statement of the ADA and the EASD. Diab
- 7) Management of hyperglycemia in type 2 diabetes 2015: update to a position statement of the ADA an
- 8) The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy o
- 9) A 26-wk, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin a
- 9.1) Comparison of basal insulin added to oral agents vs twice-daily premixed insulin as initial ins
- 9.2) Comparison betwen a basal-bolus and a premixed insulin regimen in individuals with type 2 diabe
- 9.3) Inhaled insulin: a breath of fresh air? A review of inhaled insulin. Clin Ther 2014;36:1275-89.
- 9.4) Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hype
- 9.5) Use of twice-daily exenatide in basal insulin-treated patients with type 2 diabetes: a randomiz
- 9.6) Sequential intensification of metformin treatment in type 2 diabetes with liraglutide followed
- 9.7) AACE comprehensive diabetes management algorithm 2013. Endocr Pract 2013;19:327-36.
- 9.8) AACE/ACE comprehensive diabetes management algorithm 2015. Endocr Pract 2015;21:438-47.
- 9.9) Comparison of 2 intensification regimens with rapid-acting insulin aspart in type 2 DM inadequa
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