Insulin intensification for people with type 2 diabetes: A practical approach

Fulcher, Greg, Colagiuri, Stephen, Phillips, Patrick, Prins, Johannes, Sinha, Ashim, Twigg, Stephen and Dalton, Brad (2010) Insulin intensification for people with type 2 diabetes: A practical approach. Australasian Medical Journal, 3 12: 808-813. doi:10.4066/AMJ.2010.466

Author Fulcher, Greg
Colagiuri, Stephen
Phillips, Patrick
Prins, Johannes
Sinha, Ashim
Twigg, Stephen
Dalton, Brad
Title Insulin intensification for people with type 2 diabetes: A practical approach
Journal name Australasian Medical Journal   Check publisher's open access policy
ISSN 1836-1935
Publication date 2010-01-01
Year available 2010
Sub-type Article (original research)
DOI 10.4066/AMJ.2010.466
Open Access Status DOI
Volume 3
Issue 12
Start page 808
End page 813
Total pages 6
Place of publication Perth, WA Australia
Publisher Australasian Medical Journal Pty. Ltd.
Language eng
Subject 2700 Medicine
Formatted abstract
Background: Type 2 diabetes is a progressive disorder and with time, it is appropriate for insulin therapy to be initiated in
the majority of people. Insulin is commonly initiated with once-daily basal insulin. However, when glycaemic control
becomes unsatisfactory despite the introduction of basal insulin, no clear guidelines exist for intensifying the insulin
regimen. In this article we aim to provide a clinician’s approach to both the optimisation of the basal insulin dose,
and strategies to intensify insulin therapy.

Methods: An expert consensus panel, consisting of the authors, was convened to review the current practice of insulin intensification in people with type 2 diabetes and to develop a pragmatic algorithm for clinicians. The panel reviewed the published literature on the use of insulin in clinical practice, the evidence for different intensification strategies, and the potential impact of patient-related factors on insulin choices.

Results: Insulin intensification should only be considered after the basal insulin dose has been optimised. This is achieved by taking into account basal and prandial (pre and post) blood glucose levels, individualised target HbA1c, and dietary factors. If optimal basal insulin together with oral medications is not sufficient to reach glycaemic targets, the next step is to introduce a basal plus 1 regimen or switch to twice-daily premixed insulin.  Each has advantages and disadvantages and existing guidelines do not emphasise or support any particular regimen. Therefore, it is important to individualise the
choice according to the individual’s needs. A practical algorithm has been developed to help clinicians choose an
appropriate second-line regimen

Conclusion: As beta-cell failure progresses in people with type 2 diabetes, basal insulin regimens need to be optimised and then intensified when necessary to maintain agreed glycaemic targets.
Keyword Diabetes mellitus type 2
Insulin therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: UQ Centre for Clinical Research Publications
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