title: Options for prandial glucose management in type 2 diabetes patients using basal insulin: addition of a short-acting GLP-1 analogue versus progression to basal-bolus therapy.
abstract: Integrating patient-centered diabetes care and algorithmic medicine poses particular challenges when optimized basal insulin fails to maintain glycaemic control in patients with type 2 diabetes. Multiple entwined physiological, psychosocial and systems barriers to insulin adherence are not easily studied and are not adequately considered in most treatment algorithms. Moreover, the limited number of alternatives to add-on prandial insulin therapy has hindered shared decision-making, a central feature of patient-centered care. This article considers how the addition of a glucagon-like peptide 1 (GLP-1) analogue to basal insulin may provide new opportunities at this stage of treatment, especially for patients concerned about weight gain and risk of hypoglycaemia. A flexible framework for patient-clinician discussions is presented to encourage development of decision-support tools applicable to both specialty and primary care practice.
authors.affiliation: Department of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: I B
authors.initials: IB
authors.lastname: Hirsch
authors.forename: J B
authors.initials: JB
authors.lastname: Buse
authors.forename: J
authors.initials: J
authors.lastname: Leahy
authors.forename: J B
authors.initials: JB
authors.lastname: McGill
authors.forename: A
authors.initials: A
authors.lastname: Peters
authors.forename: H W
authors.initials: HW
authors.lastname: Rodbard
authors.forename: R R
authors.initials: RR
authors.lastname: Rubin
authors.forename: J S
authors.initials: JS
authors.lastname: Skyler
authors.forename: C A
authors.initials: CA
authors.lastname: Verderese
authors.forename: M C
authors.initials: MC
authors.lastname: Riddle
mesh_terms: D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D020000:Decision Support Systems, Clinical; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D000077270:Exenatide; D005215:Fasting; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000191:economics*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069057:Insulin Detemir; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D008297:Male; D062407:Meals; D057240:Patient Preference; D018802:Patient-Centered Care; D010455:Peptides / Q000627:therapeutic use*; D014688:Venoms / Q000627:therapeutic use*; D015430:Weight Gain / Q000187:drug effects
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D010455:Peptides; D014688:Venoms; D000069057:Insulin Detemir; D052216:Glucagon-Like Peptide 1; D000077270:Exenatide
keywords: GLP-1 analogue; insulin analogues; insulin intensive management