THERAPY OF ENDOCRINE DISEASE: Insulin initiation in patients with type 2 diabetes mellitus: treatment guidelines, clinical evidence and patterns of use of basal vs premixed insulin analogues
- 1 February 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in Acta Endocrinologica
- Vol. 166 (2), 159-170
- https://doi.org/10.1530/eje-11-0022
Abstract
This review addresses the apparent disconnect between international guideline recommendations, real-life clinical practice and the results of clinical trials, with regard to the initiation of insulin using basal (long-acting) or premixed insulin analogues in patients with type 2 diabetes (T2D). English language guidelines vary considerably with respect to recommended glycaemic targets, the selection of human vs analogue insulin, and choice of insulin regimen. Randomised trials directly comparing insulin initiation between basal and premixed analogues are scarce, and hard endpoint outcome data are inadequate. The evidence presented suggests that a major component of the HbA1c not being attained in every day clinical practice may be a result of factors that are not adequately addressed in forced titration trials of highly motivated patients, including failure to comply with complex treatment and monitoring regimens. Enforced intensification of unrealistic complex treatment regimens and glycaemic targets may theoretically worsen the psychological well-being in some patients. More simple and sustainable treatment regimens and guidelines are urgently needed. As for the use of insulin in T2D, there is limited evidence to convincingly support that initiation of insulin using basal insulin analogues is superior to initiation using premixed insulin analogues. While awaiting improved clinical efficacy and cost-effectiveness data, practical guidance from national and international diabetes organisations should consider more carefully the importance of: i) being clear and consistent; and ii) the early implementation of sustainable and cost-effective insulin treatment regimens with an emphasis on optimising treatment ease of use and patient compliance.Keywords
This publication has 88 references indexed in Scilit:
- Epidemiologic Relationships Between A1C and All-Cause Mortality During a Median 3.4-Year Follow-up of Glycemic Treatment in the ACCORD TrialDiabetes Care, 2010
- Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic AdultsThe New England Journal of Medicine, 2010
- Correlates of Insulin Injection OmissionDiabetes Care, 2010
- Exenatide compared with long‐acting insulin to achieve glycaemic control with minimal weight gain in patients with type 2 diabetes: results of the Helping Evaluate Exenatide in patients with diabetes compared with Long‐Acting insulin (HEELA) studyDiabetes, Obesity and Metabolism, 2009
- Three-Year Efficacy of Complex Insulin Regimens in Type 2 DiabetesThe New England Journal of Medicine, 2009
- Effects of Intensive Glucose Lowering in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Glycaemic control among patients with type 2 diabetes mellitus in seven European countries: findings from the Real‐Life Effectiveness and Care Patterns of Diabetes Management (RECAP‐DM) studyDiabetes, Obesity and Metabolism, 2008
- A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetesDiabetologia, 2008
- Prospective randomized study for optimal insulin therapy in type 2 diabetic patients with secondary failureCardiovascular Diabetology, 2008
- Management of hyperglycaemia in type 2 diabetes: the end of recurrent failure?BMJ, 2006