Progression from Basal to Pre-mixed or Rapid-acting Insulin—Options for Intensification and the Use of Pumps

Progression from Basal to Pre-mixed or Rapid-acting Insulin—Options for Intensification and the Use of Pumps

Garber Alan J, Sharma Morali D
US Endocrinology - Volume 5 Issue 1
Published: January 2010
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Abstract
Initiating insulin therapy is an important step in the management of patients with type 2 diabetes. The insulin regimen prescribed should be physiological and designed to control fasting and post-prandial glucose levels. The primary goals of therapy are achieving and maintaining tight glycemic control. The optimal insulin regimen should be patient-specific, taking the patient’s lifestyle into consideration. As their diabetes progresses, an increasing number of patients require insulin therapy. An initial approach is to add basal insulin to oral hypoglycemic agents. When this regimen fails to achieve glycemic control, it should be intensified by either adding a rapid-acting insulin analog to control postprandial hyperglycemia or switching to pre mixed insulin injection initiated once daily and subsequently up to three times daily. More tools are now available, including injection devices, insulin pens, glucose monitoring devices, and insulin pumps, to overcome the barriers to initiating and intensifying insulin therapy. With new insulin analogs it is possible to intensify insulin therapy to achieve glycemic control targets without increasing the risk for hypoglycemia or causing excessive weight gain.

Keywords
Insulin therapy, basal insulin, pre-mixed insulin, insulin analogs, glycemic control

Disclosure: Morali D Sharma, MD, is a member of the speaker’s bureau of Bristol-Myers Squibb and AstraZeneca and has received research funding from Daiichi-Sankyo. Alan J Garber, MD, PhD, has received grants and research support from Bristol-Myers Squibb, GlaxoSmithKline, Novo Nordisk, sanofi-aventis, Merck, Sankyo, Metabasis, and Roche, is a consultant to GlaxoSmithKline, Merck, Novo Nordisk, and Roche, and is a member of the speaker’s bureau of GlaxoSmithKline, Merck, Novo Nordisk, and Sankyo.
Received: October 12, 2009 Accepted: December 17, 2009
Correspondence: Alan J Garber, MD, PhD, Professor of Medicine, Biochemistry, and Molecular Biology, and Molecular and Cellular Biology, Division of Diabetes, Endocrinology, and Metabolism, Baylor College of Medicine, 1709 Dryden, Suite 1000, Houston, TX 77030. E: agarber@bcm.edu

Support: The publication of this article is supported by Novo Nordisk, Inc. The views and opinions expressed are those of the authors and not necessarily those of Novo Nordisk.

Type 2 diabetes is a progressive disease in which beta-cell function continually declines, and most patients will eventually require insulin therapy to control hyperglycemia. In type 2 diabetes such treatment usually commences with oral antidiabetes drugs (OADs), but as betacell function declines, basal insulin is added to this regimen.1 Subsequently, as diabetes progresses, this treatment often requires augmentation with bolus or prandial dosing. An increasing body of evidence suggests that early intensive glycemic control reduces long-term vascular complications and potentially may improve betacell
function.2,3 The importance of good glycemic control to reduce the risk for the microvascular complications of hyperglycemia is well established.4–7

This review considers how the use of pre-mixed (bi-phasic) insulin preparations, rapid-acting analogs, and insulin pumps as part of the intensification process can establish better glycemic control over existing therapeutic approaches, thereby minimizing vascular complications, improving quality of life, and achieving improved costeffectiveness in treatment.

To read full article please click here: US Endocrinology - Volume 5 Issue 1.

Keywords:
Insulin therapy, basal insulin, pre-mixed insulin, insulin analogs, glycemic control, basal bolus insulin, basal insulin therapy, basal insulin secretion, intensive insulin therapy, insulin therapy type 2 diabetes, insulin therapy type 1 diabetes,

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