Lessons in initiating insulin in clinical practice.
Insulin therapy in type 2 diabetes (T2DM) can produce greater improvements in fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) than oral antidiabetic drugs (OADs). There is a growing trend to recommend initiation of insulin in T2DM patients sooner in the course of the disease, and good results have been achieved in insulin-naïve patients during randomised, controlled trials, often using aggressive dose titration algorithms. The Physicians' Routine Evaluation of Safety & Efficacy NovoMix((R)) 30 Therapy (PRESENT) study was a 6-month observational study of the safety and efficacy of biphasic insulin aspart 30 (BIAsp 30) as monotherapy or in combination with OADs in inadequately controlled patients with T2DM. This review article compares results from those patients who entered the study insulin-naïve (either with or without previous OAD treatment), with results from randomised, controlled trials of BIAsp 30 in insulin-naïve T2DM patients. It aims to provide guidance on the initiation of insulin in patients with T2DM, focusing on the efficacy of BIAsp 30 when used for this purpose, and highlighting both the low risk of hypoglycaemia associated with therapy, and the availability of delivery devices that can minimise injection site discomfort and help to overcome psychological insulin resistance.
Sharma
Surendra K
SK
MG Medical College, Jaipur, India. sksharma7@gmail.com
Yeo
Jing Ping
JP
Garber
Alan
A
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D015337:Multicenter Studies as Topic
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin