title: Choosing injectable therapy: The metabolic fulcrum.
abstract: This clinical decision making hypothesis utilizes the metabolic fulcrum based approach to classify persons with diabetes into three categories: predominantly catabolic, eubolic, and predominantly [maladaptive] anabolic. This systematic arrangement helps define choice of injectable therapy in type 2 diabetes mellitus. Patients with predominant catabolism, may respond better to intensive insulin therapy. Dual action insulin, including premixed insulin and I Deg Asp (insulin degludec aspart), may be an acceptable alternative. Uncomplicated, eumetabolic patients with type 2 diabetes may use any of the various drugs available. Patients classified as having maladaptive anabolism may benefit from a GLP1RA. If this does not suffice, a GLP1RA + basal insulin combination may be effective.
authors.affiliation: Department of Endocrinology, Bharti Hospital, Karnal, New Delhi, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kalra
authors.affiliation: Department of Endocrinology, AIIMS, New Delhi, India.
authors.forename: Yashdeep
authors.initials: Y
authors.lastname: Gupta
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology; D007328:Insulin / Q000494:pharmacology*; D008660:Metabolism; D018579:Patient Selection
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Anabolism, Catabolism, Degludec, Detemir, Exenatide QW,   Glargine, GLP1RA, Insulin, Liraglutide, Metabolism.