Consensus evidence-based guidelines for insulin initiation, optimization and continuation in type 2 diabetes mellitus

The prevalence of diabetes continues to increase despite advances in detection and therapy. Majority of the patients fail to achieve desired glycaemic targets even with maximal tolerated doses of oral anti-hyperglycaemic drugs, necessitating insulin therapy. Although, much attention has been given to early insulin initiation, yet substantial proportion of patients do not achieve glycaemic targets as they fail to initiate or intensify insulin therapy at the appropriate time. The choice of an insulin regimen and timely initiation and intensification of insulin therapy are key factors in achieving optimal glycaemic control. This current consensus guideline developed by a panel of experts aims to provide specific recommendations based on existing guidelines and published data on initiation and intensification of insulin therapy in management of type 2 diabetes mellitus (T2DM) using basal, premixed and basal-bolus insulin regimens in Indian clinical practice. The panel recognized the need to upgrade the existing guidelines for management of T2DM and endorsed recommendations that are in line with Indian insulin guidelines.