Best Practices and Tools for Titrating Basal Insulins: Expert Opinion from an Indian Panel via the Modified Delphi Consensus Method

Abstract

Aim: To develop an evidence-based expert group consensus document on the best practices and simple tools for titrating basal insulins in persons with type 2 diabetes mellitus (T2DM). Background: Glycemic control is suboptimal in a large proportion of persons with T2DM, despite insulin therapy, thereby increasing the risk of potentially severe complications. Early initiation of insulin therapy and appropriate dose titration are crucial to achieving glycemic targets. Attitudes and practices among healthcare professionals (HCPs) and perceptions about insulin therapy among persons with diabetes contribute largely to suboptimal glycemic control. Improving HCP-patient communication, encouraging the use of additional educational tools, and providing support for the titration process to increase confidence, both at the initiation visit and at home, facilitate the optimization of dose titration. In Indian settings, specific guidelines and a consensus statement are lacking on the optimal insulin initiation dose, frequency of dose titration, and basal insulin profile needed to achieve optimal

Insulinization in T2DM with Basal Analogues During COVID-19 Pandemic: Expert Opinion from an Indian Panel

“…A further advantage with basal insulin analogues like glargine 100 U/mL (Gla-100), detemir, glargine 300 U/mL (Gla-300), and degludec (IDeg) is that they involve only one injection per day and do not require adherence to inflexible meal patterns or quantity and composition of the diet [ 9 ]. It is also pertinent to note that newer second-generation basal insulin analogues like Gla-300 and IDeg have lower glycemic variability, greater flexibility in dosing, and a sustained glucose-lowering effect with lesser risk of hypoglycemia [ 11 ].…”

“…Self-monitoring of blood glucose (SMBG) constitutes one of the key tools in T2DM management in general and in insulin therapy in particular. This is because, once initiated, non-optimally titrated insulin leads to treatment dissatisfaction, discontinuation, and suboptimal glycemic control [ 11 ].…”

“…Safer and easier titration is facilitated by basal insulin compared with other insulin regimens, which works well with different titration algorithms [ 11 ]. The first head-to-head randomized controlled trial between the two second-generation basal insulins, Gla-300 and IDeg-100, in insulin-naïve people with T2DM has indicated lower risk of hypoglycemia during the titration period (initial 12 weeks) with Gla-300 [ 12 ].…”

Effective Overall Glycaemic Control with Fast-Acting Insulin Aspart Across Patients with Different Baseline Characteristics: A Post Hoc Analysis of the Onset 9 Trial

“…Rapid-acting insulin analogues are used to control PPG excursions, and are effective in doing so because their pharmacokinetic/pharmacodynamic profile approximates that of endogenous insulin secretion in response to meals [14]. With basal insulin, the majority of treatment effect on glycaemic control is achieved by 12 weeks after dose optimisation [15,16]. Clinically, the healthcare practitioner can then optimise the bolus insulin regimen.…”

Usefulness of YouTube™ videos in training patients for blood glucose self-monitoring in current coronavirus disease-19 pandemic

“…[ 2 ] It is an excellent tool for adjustments of insulin dosage in patients suffering from diabetes mellitus. [ 3 , 4 ]…”