Options for intensification of basal insulin in type 2 diabetes: Premeal insulin or short-acting GLP-1 receptor agonists?

Diabetes & Metabolism
P Darmon, Denis Raccah

Abstract

Type 2 diabetes is an evolutive disease with a progressive defect of beta-cell insulin secretion. This characteristic points to a need for treatment that takes into account such a natural history. When oral antidiabetic drugs fail to achieve the patient's target HbA1c level, basal insulin treatment is usually initiated and titrated in association with oral drugs to manage fasting hyperglycaemia. Over a period of time, it is enough to simply achieve the HbA1c target. However, when even a good fasting blood glucose level is no longer sufficient to control overall glycaemia, then prandial treatment must be combined with the titrated basal insulin to deal with the postprandial hyperglycaemia responsible for the elevation of HbA1c. Of the different therapeutic options now available for this, rapid-acting insulins and GLP-1 receptor agonists (RAs) can be used. Rapid-acting insulins can be added either at each meal, achieving full insulin supplementation with a basal-bolus regimen, or at the main meal only as a "basal-plus" regimen. Compared with the full basal-bolus, the basal-plus strategy is associated with fewer injections, yet provides similar efficacy in terms of HbA1c improvement, but with less weight gain and lower hypoglycaem...Continue Reading

References

Nov 23, 2006·Diabetes Research and Clinical Practice·Gerrard RaymanMichelle Middle
Feb 23, 2007·Diabetes/metabolism Research and Reviews·Denis RaccahMatthew Riddle
May 10, 2011·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Luigi MeneghiniKjeld Hermansen
Jan 25, 2012·Diabetic Medicine : a Journal of the British Diabetic Association·B T BlakT Ivanyi
Jun 1, 2012·Diabetes, Obesity & Metabolism·J J Holst, T Vilsbøll

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Citations

Jun 11, 2020·Revista da Associação Médica Brasileira·Héctor Eloy Tamez-PérezAlejandra Lorena Tamez-Peña

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