Comment on: Nathan DM, Buse JB, Davidson MB et al (2006) Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 49:1711–1721

Cerasi, E

doi:10.1007/s00125-006-0573-0

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…In clinical practice, the treatment approach for newly diagnosed patients tends to rely on the experience of the physician in identifying the right combination of lifestyle interventions and medications for each patient and in promoting adherence to long-term therapy [ 24 ].…”

Section: Initial Diagnosis and Treatment Of Patients With Type 2 Diabmentioning

confidence: 99%

“…However, given the expected decreases in A1C with OAD monotherapy, oral agents may not lower plasma glucose levels sufficiently to reach target A1C levels. In contrast, insulin can lower A1C by ≥2.5%, and therefore this therapy has the potential to decrease any level of elevated A1C to, or close to, the therapeutic goal when used in appropriate doses [ 24 ].…”

Section: Need For Early Insulin Therapymentioning

confidence: 99%

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The Importance of Early Insulin Adoption in Type 2 Diabetes Management

2009

IJFP

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Type 2 diabetes mellitus (T2DM) is deadly and costly and there is a need to ensure proper treatment in order to prevent the advance of this chronic progressive disorder and its complications. Comprehensive interventions targeted at glycemic control are essential for the long-term health of patients with T2DM at lower cost. Timely initiation of insulin therapy is an important component of management. However, there is often a lengthy delay from diagnosis until initation of insulin therapy, which can be further hampered by reluctance to initiate therapy from healthcare providers and patients. This delay means that patients can incur a heavy burden of uncontrolled hyperglycemia over several years. Benefits of early insulin therapy need to be conveyed to both patients and healthcare professionals through targeted education. In the future, combining modern insulins with improvements in patient education should help facilitate early initiation of insulin and make this approach more widely adopted.

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Section: Initial Diagnosis and Treatment Of Patients With Type 2 Diabmentioning

confidence: 99%

Section: Need For Early Insulin Therapymentioning

confidence: 99%

The Importance of Early Insulin Adoption in Type 2 Diabetes Management

2009

IJFP

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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

Vaag

Lund

2012

European Journal of Endocrinology

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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.

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Cited by 2 publications

References 7 publications

The Importance of Early Insulin Adoption in Type 2 Diabetes Management

The Importance of Early Insulin Adoption in Type 2 Diabetes Management

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

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