Basal insulin initiation in type 2 diabetes guidelines published
Guidance for effective initiation and titration of basal insulin in type 2 diabetes has been published by a panel of experts from Canada.
Published by the Diabetes Therapy journal, it was developed by a multidisciplinary panel to address frequently asked questions on basal insulin initiation and titration.
The article, Insulin Matters: A Practical Approach to Basal Insulin Management in Type 2 Diabetes, establishes simple and practical guidelines for diabetes healthcare professionals in a bid to improve glycaemic outcomes in clinical practice.
The panel said: “Although hyperglycaemia is associated with serious complications, it is well established that improved glycemic control reduces the risk of microvascular complications and can also reduce cardiovascular (CV) complications over the long term.
“The UKPDS and ADVANCE landmark trials have resulted in diabetes guidelines recommending an A1C target of ≤ 7.0% for most patients or a target of ≤ 6.5% to further reduce the risk of nephropathy and retinopathy in those with type 2 diabetes (T2D), if it can be achieved safely. However, half of the people with T2D in Canada are not achieving these glycemic targets, despite advances in diabetes pharmacological management.
“There are many contributing factors to account for this poor outcome; however, one of the major factors is the delay in treatment advancement, particularly a resistance to insulin initiation and intensification. To simplify the process of initiating and titrating insulin in T2D patients, a group of Canadian experts reviewed the evidence and best clinical practices with the goal of providing guidance and practical recommendations to the diabetes healthcare community at large. ”
The paper concluded: “Several factors underlie the importance of the initiative put forth by this expert panel: there is a rising prevalence of diabetes; half of the T2D [type 2 diabetes] population is not at target, among which 61 per cent were receiving insulin therapy, suggesting delayed insulin initiation and intensification; there are multiple titration algorithms to choose from which adds to the confusion and complexity for patients and providers; and the arrival of new long-acting basal insulins and other pharmacological and technological advances that require consideration.”
The expert panel included GPs, nurses, nurse practitioners, endocrinologists, dieticians, pharmacists, and a psychologist. This article summarizes the panel recommendations.
To access the guidance, click here.