Insulin for type 2 diabetes: choosing a second-line insulin regimen.
Guidance has been published on the choice of initial insulin regimen for patients with type 2 diabetes [NPH (isophane) insulin or a long-acting insulin analogue] but not on how to choose a second regimen when glycaemic control becomes unsatisfactory.


OBJECTIVE
To develop pragmatic clinical guidance for choosing a second-line insulin regimen tailored to the individual needs of patients with type 2 diabetes after failure of first-line insulin therapy.


METHODS
Formulation of a consensus by expert panel based on published evidence and best clinical practice, taking into account patient preferences, lifestyle and functional capacity.


RESULTS
Six patient-dependent factors relevant to the choice of second-line insulin regimen and three alternative insulin regimens (twice-daily premixed, basal-plus and basal-bolus) were identified. The panel recommended one or more insulin regimens compatible with each factor, emphasising the fundamental importance of a healthy lifestyle that includes exercise and weight reduction. These recommendations were incorporated into an algorithm to provide pragmatic guidance for clinicians.


CONCLUSIONS
The three alternative insulin regimens offer different benefits and drawbacks and it is important to make the right choice to optimise outcomes for patients.
Barnett
A
A
University of Birmingham and Heart of England NHS Foundation Trust, Birmingham, UK. anthony.barnett@heartofengland.nhs.uk
Begg
A
A
Dyson
P
P
Feher
M
M
Hamilton
S
S
Munro
N
N
D000465:Algorithms; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004032:Diet; D005215:Fasting / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008019:Life Style; D010349:Patient Compliance; D010353:Patient Education as Topic; D015430:Weight Gain
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin