Options for prandial glucose management in type 2 diabetes patients using basal insulin: addition of a short‐acting GLP‐1 analogue versus progression to basal‐bolus therapy

Abstract

Integrating patient-centered diabetes care and algorithmic medicine poses particular challenges when optimized basal insulin fails to maintain glycaemic control in patients with type 2 diabetes. Multiple entwined physiological, psychosocial and systems barriers to insulin adherence are not easily studied and are not adequately considered in most treatment algorithms. Moreover, the limited number of alternatives to add-on prandial insulin therapy has hindered shared decision-making, a central feature of patient-centered care. This article considers how the addition of a glucagon-like peptide 1 (GLP-1) analogue to basal insulin may provide new opportunities at this stage of treatment, especially for patients concerned about weight gain and risk of hypoglycaemia. A flexible framework for patient-clinician discussions is presented to encourage development of decision-support tools applicable to both specialty and primary care practice.

Basal insulin combined incretin mimetic therapy with glucagon-like protein 1 receptor agonists as an upcoming option in the treatment of type 2 diabetes: a practical guide to decision making

“…Regarding the choice between basal insulin combined incretin mimetic therapy with GLP-1 RAs (BIT) and BOTplus, the authors of a recently published paper suggested a very useful sample checklist for determining patient preference [Hirsch et al 2014], which in the last line of Figure 4 is the crucial parameter. We suggest using the checklist for the evaluation of patient preference.…”

“…All the above-mentioned guidelines, consensus reports, position statements and recommendations suggest a discussion of benefits, disadvantages and risks of a suggested therapy with the patient as part of individualized therapeutic concepts. Regarding the choice between basal insulin combined incretin mimetic therapy with GLP-1 RAs (BIT) and BOTplus, the authors of a recently published paper suggested a very useful sample checklist for determining patient preference [Hirsch et al 2014], which in the last line of Figure 4 is the crucial parameter. We suggest using the checklist for the evaluation of patient preference.…”

Intensification of Basal Insulin Therapy with Lixisenatide in Patients with Type 2 Diabetes in a Real-World Setting: The BASAL-LIXI Study

“… 21 The advantages of a prandial/postprandial control with GLP-1 RAs instead of short-acting insulin taken during the main meals are that there is a lower risk of hypoglycemia, a body weight reduction, 22 and relief from the burden of frequent self-monitoring of blood glucose. 12 , 23 , 24 , 25 …”

Satisfaction of switching to combination therapy with lixisenatide and basal insulin in patients with type 2 diabetes receiving multiple daily insulin injection therapy: A randomized controlled trial

“…For example, in a trial including 82 patients with type 2 diabetes who switched from MDI to a single agent of liraglutide or insulin detemir plus sitagliptin, the treatment satisfaction (DTSQ score) was significantly improved in the liraglutide group after 24 weeks. In these trials, patient satisfaction using GLP‐1 receptor agonists or MDI was assessed as a secondary outcome.…”