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[Present and future of insulin therapy in type 2 diabetic patients]
1Service d'Endocrinologie, Hôtel-Dieu, 44093 Nantes. Bernard.Charbonnel@sante.univ-nantes.fr
Abstract:
Type 2 diabetes natural history and progressive deterioration requires a therapeutic approach starting with diet and physical activity changes, then associated with pharmacological interventions (monotherapy, then multiple therapy). When oral anti-diabetics at optimal dosage have failed to maintain good diabetic control (HbA1c 6.5% Pounds), insulin treatment has to be considered and should be used when diabetic controls remain poor (HbA1c > 8%). The most adequate insulin regimen are bedtime NPH associated or not with oral anti-diabetics, or alternatively 2 daily injections (morning and evening) of intermediate insulin. Intensive insulin (3 daily injections or more), and particularly the use of short-acting analogues is an effective regimen when bedtime or conventional regimen have failed. Insulin glargin could be an interesting alternative to bedtime NPH but needs further data in type 2 diabetes. Insulin treatment has to be initiated with an adequate patient (and family) education. Glycaemic objectives (fasting blood glucose and HbA1c) should be regularly assessed and adapted taking into consideration diabetic control, clinical effects and safety assessments (weight gain, hypoglycaemic events...).
Insights
Type 2 diabetes management progresses from lifestyle changes to medications. Insulin therapy is essential when oral drugs fail, with various regimens available to optimize glycemic control and patient safety.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Type 2 diabetes is characterized by progressive deterioration requiring evolving therapeutic strategies.
- Initial management involves lifestyle modifications and oral anti-diabetic agents.
- Pharmacological interventions escalate from monotherapy to combination therapy.
Purpose of the Study:
- To outline the natural history and therapeutic progression for type 2 diabetes.
- To define criteria for initiating insulin therapy.
- To review effective insulin regimens and management considerations.
Main Methods:
- Review of current treatment guidelines and clinical practice for type 2 diabetes management.
- Analysis of pharmacological interventions, including oral agents and various insulin types.
- Consideration of patient education and monitoring parameters.
Main Results:
- Insulin therapy is indicated when oral anti-diabetics fail to achieve glycemic targets (HbA1c > 8%).
- Recommended insulin regimens include bedtime NPH or twice-daily intermediate-acting insulin.
- Intensive insulin regimens, including short-acting analogues, are effective when conventional methods fail.
Conclusions:
- Insulin treatment initiation requires comprehensive patient education.
- Regular assessment and adaptation of glycemic targets are crucial.
- Monitoring for weight gain and hypoglycemia is essential for safe and effective diabetes management.