Strategy of insulin intensification after basal failure for type 2 diabetes in the outpatient setting

Type 2 diabetes has become a worldwide pandemic and the problem continues to grow. As the disease progresses, the majority of patients will require insulin therapy within 6 years of diagnosis. During the therapy, evaluation and intensification of the current treatment is required in order to achieve the good glycaemic state. In patients who are taking basal insulin or premix OD but failing to achieve the recommended glycaemic targets of HbA1c <6.5%-7%, one option is to intensify to a modern premixed insulin BID or TID. Its formulations have both basal and short or rapid-acting insulin capabilities, enabling them to cover both fasting and postprandial blood glucose levels. Other strategy is known as basal-plus method, basal plus 1 and then basal plus 2. This strategy is used by adding OD short-acting or rapid-acting insulin (analog) before having largest portion meal or before meal when blood glucose before the next meal is high. It is very important for clinicians to have the capability of choosing the right regimen based on individual's need and applying the right strategy to intensify the insulin therapy for their patients.