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Strategies for implementing effective mealtime insulin therapy in type 2 diabetes
Mark Peyrot1, Timothy S Bailey2, Belinda P Childs3
1a Loyola University Maryland , Baltimore , MD , USA.
Current Medical Research and Opinion
|February 13, 2018
Summary
Intensifying type 2 diabetes treatment with basal-bolus insulin can improve glucose control. Addressing patient barriers and using technology can help primary care providers implement effective mealtime insulin therapy.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Type 2 diabetes mellitus (T2D) is a global health crisis.
- Progression of T2D often necessitates insulin therapy, typically basal insulin for 24-hour glucose management.
Purpose of the Study:
- To outline considerations for primary care providers (PCPs) in escalating treatment when basal insulin alone is insufficient.
- To address challenges in initiating and optimizing mealtime insulin therapy for T2D patients.
Main Methods:
- This is an opinion paper, not a clinical trial.
- Discussion of treatment strategies, patient-centered behavioral/emotional barriers, and technological aids.
Main Results:
- Achieving A1c goals (<7.0%) requires controlling both fasting and mealtime hyperglycemia.
- Barriers include "psychological insulin resistance" in patients and clinical inertia in PCPs.
- Simplified algorithms, advanced insulin delivery devices, and collaborative decision-making can overcome these barriers.
Conclusions:
- Effective basal-bolus insulin regimens can be implemented in T2D.
- These regimens can enhance glucose control without negatively impacting quality of life, treatment satisfaction, or psychological well-being.
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