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Intensifying insulin therapy: what options are available to patients with type 2 diabetes?

Luigi F Meneghini1

  • 1University of Miami Miller School of Medicine, Miami, Fla 33157, USA. lmeneghi@med.miami.edu

The American Journal of Medicine
|August 20, 2013
PubMed

Insights

Type 2 diabetes (T2D) management requires therapy intensification as beta-cell function declines. Insulin therapy, including basal, prandial, or premixed options, is often necessary, with novel combinations showing promise.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacology

Background:

  • Type 2 diabetes (T2D) is a progressive condition characterized by declining beta-cell function.
  • Standard therapies like metformin may not prevent disease progression, often necessitating insulin replacement.
  • Effective management requires timely evaluation and treatment intensification.

Purpose of the Study:

  • To review therapeutic intensification strategies for type 2 diabetes.
  • To discuss the role of insulin therapy in managing progressive T2D.
  • To explore the potential of combining insulin with newer antidiabetic agents.

Main Methods:

  • Literature review of T2D management guidelines and clinical studies.
  • Analysis of insulin therapy initiation and intensification options.
  • Evaluation of combination therapies involving insulin and incretin-based agents.

Main Results:

  • Basal insulin offers a flexible platform for stepwise intensification with prandial insulin.
  • Premixed insulin regimens are effective, particularly in insulin-naïve patients.
  • Combining insulin with incretin-based therapies may improve glycemic control and mitigate side effects.

Conclusions:

  • Insulin therapy is a crucial component in managing advanced T2D.
  • Stepwise insulin intensification strategies are vital for achieving glycemic targets.
  • Further research is needed to fully establish the role of novel combination therapies.
Keywords:
Basal insulin intensificationBasal plus insulin therapyBasal-bolus therapyhypoglycemia

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