Starting Insulin Therapy in Type 2 Diabetic Patients

Davidson, Mayer B.

doi:10.2337/diacare.28.2.494

Cited by 20 publications

(14 citation statements)

References 15 publications

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“…The UKPDS was one of the first studies to prospectively investigate outcomes in insulin-plus-OAD-treated patients with T2DM, and it showed that the risk of complications can be considerably reduced when ‘near-normal’ glycemic control is achieved (Davidson 2005; UKPDS 33 1998). It demonstrated that early addition of insulin to oral therapy can safely keep HbA1c close to 7.0% in the first 6 years after diagnosis (47% of patients in the SU with insulin group vs. 35% in insulin only group).…”

Section: Insulin With Oads and The Treat-to-target Conceptmentioning

confidence: 99%

Combining insulins with oral antidiabetic agents: effect on hyperglycemic control, markers of cardiovascular risk and disease

Hermansen

Mortensen²,

Hermansen³

2008

VHRM

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Abstract:Patients with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular disease (CVD). Unfortunately, several potential barriers exist for CVD risk management in diabetes, including the need for signifi cant lifestyle changes, potential problems with hypoglycemia, weight gain, injection tolerability, treatment complexity with current diabetes therapies and other, unmodifi able factors. Improving glycemic control may impact CVD risk. Treatment of T2DM usually starts with lifestyle changes such as diet and exercise. When these become insuffi cient, pharmacotherapy is required. Various oral antidiabetic drugs (OADs) are available that reduce hyperglycemia. The fi rst line of therapy is usually metformin, since it does not increase weight and seems to have a benefi cial effect on CVD mortality and risk factors. As T2DM progresses, insulin treatment becomes necessary for the majority of patients. The last few years have seen the development of long-acting, rapid-acting, and premixed insulin analog formulations. The treat-to-target algorithms of recent studies combining OADs plus insulin analogs have demonstrated that patients can reach glycemic treatment targets with low risk of hypoglycemia, greater convenience, and -with some analogs -limited weight gain vs conventional insulins. These factors may possibly have a positive infl uence on CVD risk. Future studies will hopefully elucidate the benefi ts of this approach.

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Section: Insulin With Oads and The Treat-to-target Conceptmentioning

confidence: 99%

Combining insulins with oral antidiabetic agents: effect on hyperglycemic control, markers of cardiovascular risk and disease

Hermansen

Mortensen²,

Hermansen³

2008

VHRM

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“…8 Davidson 9 commenting on these two studies concludes that it probably makes little difference which insulin regimen is used to treat type 2 diabetes patients who fail to maintain glycaemic control with oral agents alone.…”

Section: Discussionmentioning

confidence: 99%

Is it time to re-assess the role of gliclazide? Targeting insulin resistance in type 2 diabetes patients suboptimally controlled with insulin

Brown¹

2006

Postgraduate Medical Journal

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Background Adult patients with type 2 diabetes controlled with insulin frequently require the addition of insulin sensitising drugs such as metformin and sometimes glitazones to achieve optimum glycaemic control. Five of a group of eight people with suboptimal diabetes control who were treated by the introduction of gliclazide are reported on. Three patients were excluded. One with type 1 diabetes and two others who had dietary or other therapeutic interventions coinciding with re-introduction gliclazide. Does the re-introduction of gliclazide effect a clinically significant improvement in glycaemic control in type 2 diabetes patients with suboptimal control taking combinations of short and long acting insulin plus metformin? Method Five adult patients with type 2 diabetes with suboptimal control using combinations of short and long acting insulin plus metformin who were adherent to their dietary regimen were treated by the addition of gliclazide at different doses. Two of the patients were taking pioglitazone in addition to metformin and insulin. Their glycaemic control was monitored over the following six months. Results All five showed significant improvement in glycaemic control after three months. Mean reduction in HbA1c was 1.4% (range 0.9% to 2.5%). Six months after the introduction of gliclazide four patients had HbA1c below base line figure and in two patients clinically significant improvement had been maintained. Conclusion A double blind randomised placebo control study is necessary to evaluate a possible role for gliclazide in type 2 diabetes patients who have suboptimal glycaemic control using combinations of short and long acting insulin plus metformin.

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“…Titration was based on a treat-to-target [11,12] pattern management approach, with breakfast 70/30 titrated based on predinner values and evening 70/30 titrated based on fasting values, whereas glargine was titrated based only on fasting values as usual. If plasma glucose levels from the prior 3 days showed two of three reading out of range for a time period and no hypoglycemia, the insulin dose was titrated up based on the lower of the two plasma glucose values (before breakfast and dinner).…”

Section: Aimsmentioning

confidence: 99%

Clinical trials report

McCall¹

2005

Curr Diab Rep

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Riddle MC, et al.: Comparison of basal insulin added to oral agents versus twicedaily premixed insulin as initial insulin therapy for type 2 diabetes. Diabetes Care 2005, 28:254-259. Rating: •Of importance.Introduction: A recent survey by the American Association of Clinical Endocrinologists (AACE) has indicated that more than two thirds of patients with diabetes do not meet the standards of care (ie, they do not have A 1c concentrations below 6.5%) [1,2]. Barriers to achieving this goal include failure to recognize type 2 diabetes as a progressive disorder, lack of timely progression of therapy, and reluctance to initiate insulin when needed. Both patients and doctors often hesitate to start insulin. One concern is lack of clarity on the best way to start insulin. Another concern relates to the newly recognized importance of prandial hyperglycemia control as one approaches A 1c targets [3]. Thus, when and how to start insulin is not the only issue-when and how to start meal insulin is also important. Two recent papers have compared regimens for insulin initiation and come to different conclusions. Both are discussed in this report. Aims:To compare the efficacy and safety of adding oncedaily basal insulin versus switching to twice-daily premixed insulin in patients with type 2 diabetes insufficiently controlled by oral antidiabetic drugs (OADs).Methods: This is a 24-week-long, randomized, open-label, parallel, multicenter, multinational (66 sites, 10 European countries) trial to compare the efficacy and safety of achieving American Diabetes Association criteria for good control (< 7%) and to do so without nocturnal hypoglycemia. The two insulin regimens were insulin glargine given before breakfast added to previously used OADs versus discontinuing OADs and switching to a fixed-ratio neutral protamine Hagedorn (NPH) and regular combination (70/30) twice daily at breakfast and supper. Secretagogues were changed to glimepiride 3 to 4 mg/d but dosage was not adjusted. Metformin was prescribed at the prestudy dosage without any titration. Patients were included if they had type 2 diabetes for at least 1 year and were on stable metformin and sulfonylureas for at least 1 month, were between 35 to 75 years old, had a body mass index ≤ 35, had an A 1c between 7.5 and 10.5, and had a fasting glucose ≥ 120 mg/dL.

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Starting Insulin Therapy in Type 2 Diabetic Patients

Cited by 20 publications

References 15 publications

Combining insulins with oral antidiabetic agents: effect on hyperglycemic control, markers of cardiovascular risk and disease

Combining insulins with oral antidiabetic agents: effect on hyperglycemic control, markers of cardiovascular risk and disease

Is it time to re-assess the role of gliclazide? Targeting insulin resistance in type 2 diabetes patients suboptimally controlled with insulin

Clinical trials report

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