Gla-100 Initiation: The When, Why, and How

Early insulin initiation benefits people with diabetes by inducing a rapid and sustained glycemic control along with preventing the onset of adverse legacy effects early in the disease course. This has an over-arching effect as it could possibly modify the disease course and prevent the development of vascular complications, as has been attested to in landmark studies like the UKPDS and GRACE. Insulin glargine 100 U/mL (Gla-100) has been extensively studied under various scenarios as the initial insulin administered early in T2DM disease course, registering significant glycemic and vascular benefits over the standard of care. By virtue of its ease of use and better safety profile, basal insulin like Gla-100 has been recommended by various international and Indian guidelines as the go-to initial insulin in people with diabetes. Further, the ability to personalize the initiating dose basis one's HbA1c and weight is an additional feature that contributes to the scientific merit of initiating with basal insulin like Gla-100. However, early insulin initiation is mostly delayed owing to 'clinical inertia,' thereby causing an evitable glycemic burden. Therefore, physicians managing diabetes must aim to increase acceptance, persistence, and adherence to insulin therapy by focusing on the safety, simplicity, and convenience of therapies.