title: Benefits of timely basal insulin control in patients with type 2 diabetes.
abstract: Worldwide, both underdiagnosis and undertreatment leave many patients exposed to long periods of hyperglycemia and contribute to irreversible diabetes complications. Early glucose control reduces the risk of both macrovascular and microvascular complications, while tight control late in diabetes has little or no macrovascular benefit. Insulin therapy offers the most potent antihyperglycemic effect of all diabetes agents, and has a unique ability to induce diabetes remission when used to normalize glycemia in newly diagnosed patients. When used as a second-line therapy, basal insulin is more likely to safely and durably maintain A1C levels ≤7% than when insulin treatment is delayed. The use of basal insulin analogs is associated with a reduced risk of hypoglycemia and weight gain compared to NPH insulin and pre-mixed insulin. Patient self-titration algorithms can improve glucose control while decreasing the burden on office staff. Finally, recent data suggest that addition of incretin agents to basal insulin may improve glycemic control with very little, if any increased risk of hypoglycemia or weight gain.
authors.affiliation: Tulane University Health Sciences Center, New Orleans, LA.
authors.forename: Dragana
authors.initials: D
authors.lastname: Lovre
authors.affiliation: Tulane University Health Sciences Center, New Orleans, LA. Electronic address: vfonseca@tulane.edu.
authors.forename: Vivian
authors.initials: V
authors.lastname: Fonseca
mesh_terms: D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D018450:Disease Progression; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D050177:Overweight / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D011788:Quality of Life
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Basal insulin; Glycemic goals; Insulin initiation; Insulin titration; Insulin treatment; type 2 diabetes mellitus