EADSG Guidelines: Insulin Therapy in Diabetes

Area of Science:

• Endocrinology and Metabolism
• Pharmacology
• Diabetes Care

Background:

• Insulin is the primary treatment for type 1 diabetes mellitus (T1DM).
• Exogenous insulin therapy is indicated for type 2 diabetes mellitus (T2DM) in specific clinical scenarios, including failure of oral agents or pregnancy.
• Establishing confirmed diabetes diagnosis is a prerequisite for insulin initiation.

Purpose of the Study:

• To outline current recommendations for insulin therapy initiation and management in T1DM and T2DM.
• To emphasize the importance of individualized insulin regimens and blood glucose monitoring.
• To highlight best practices in insulin administration techniques and complication prevention.

Main Methods:

• Review of established guidelines and evidence for insulin therapy in diabetes mellitus.
• Analysis of treatment targets, including glycated hemoglobin A1c (HbA1c).
• Discussion of insulin regimens, monitoring strategies, and injection techniques.

Main Results:

• Insulin initiation in T1DM typically involves multiple daily injections, with a target HbA1c <7.5% for children.
• In T2DM, insulin is considered with HbA1c ≥7.5%, with preferred initiation using basal or premixed insulin, potentially combined with other agents.
• Effective insulin therapy relies on regular blood glucose monitoring (SMBG, FPG, PPG) and appropriate injection techniques to avoid complications like lipohypertrophy.

Conclusions:

• Individualized insulin therapy, guided by blood glucose monitoring, is essential for managing T1DM and T2DM.
• Adherence to recommended injection practices, including needle length and site rotation, is critical for safety and efficacy.
• Healthcare providers should be aware of risks associated with specific insulin administration practices, such as needle reuse and long needles in children.