Insulin initiation and intensification: insights from new studies

Tight glycemic control is central to reducing the risk of long-term macrovascular and microvascular complications of type 2 diabetes and the associated morbidity and mortality. However majority of the patients do not achieve glycemic targets (HbA1c < 7%). Once insulin treatment has been initiated, each patient's regimen must be optimized and intensified to reach the target. In many guidelines, initial insulin therapy comprises a single dose of long-acting insulin or premixed insulin. Basal insulin will help to control fasting plasma glucose (FPG) level, but postprandial glucose excursions make a significant contribution to the overall daily hyperglycemia of type 2 diabetic patients. BIAsp 30 is the most prescribed analog premix and consequently has the largest evidence base in terms of randomized controlled trials (RCTs) and observational data. It follows that BIAsp 30 is therefore the analog premix most likely to be used for insulin intensification, both from basal insulin and from BIAsp 30 regimens: OD to BID and from BID to TID.