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[Therapeutic options for a type 2 diabetic patient not well controlled with metformin plus basal insulin]
André J Scheen1,2, Nicolas Paquot1
1Université de Liège, Service de diabétologie, nutrition et maladies métaboliques, CHU Sart Tilman, 4000 Liège, Belgique.
Abstract:
In a patient with type 2 diabetes not well controlled with a basal insulin - metformin combination, several therapeutic options may be considered: intensifying insulin therapy with different schemes (appropriate titration using a more favourable basal insulin analogue, adding one, two or three rapid-acting insulin analogues, shift to two or three premix insulin injections), adding a dipeptidyl peptidase-4 inhibitor (gliptin) or an inhibitor of sodium-glucose cotransporters type 2 (gliflozin), or combining a glucagon-like peptide-1 receptor agonist with basal insulin. The choice should be made according the individual profile and preference of the patient, in a personalized approach, taking into account the advantages and disadvantages of each therapeutic solution.
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