Intensification of insulin therapy in patients with type 2 diabetes mellitus: An algorithm for basal-bolus therapy

Abstract

The incidence of diabetes mellitus is projected to continue to increase worldwide over the next 20 years leading to increased costs in the management of the disease and its associated co-morbidities. Insulin replacement is one of many treatment options that can help to bring about near normoglycemia in the patient with type 2 diabetes mellitus (T2DM). Glycemic control as close to normoglycemia as possible can help to reduce the risk of microvascular and macrovascular complications, yet less than one-half of patients with T2DM achieve glycemic targets as recommended by practice guidelines. The purpose of this review is to provide guidance to primary care physicians for the initiation and intensification of basal-bolus insulin therapy in patients with T2DM. Two treatment algorithms that can be both patient- and physician-driven are proposed: a stepwise approach and a multiple daily injections approach. Evidence shaping the two approaches will be discussed alongside management issues that surround the patient treated with insulin: hypoglycemia, weight gain, patient education, and quality of life.

Key words::

• Basal-bolus
• insulin
• intensification
• type 2 diabetes mellitus

Acknowledgements

The authors thank Robert Schupp, PharmD, and Alan J. Klopp, PhD, of inScience Communications, Springer Healthcare, for providing medical writing support.

Declaration of interest: Preparation of this manuscript was supported by Novo Nordisk, US. The authors did not receive any compensation for this work.

During the past year, Martin Abrahamson has served as an advisory board consultant for Boehringer Ingelheim, Halozyme, and Novo Nordisk.

Anne Peters has served as an advisory board consultant for Amylin Pharmaceuticals, Eli Lilly, and Novo Nordisk and has spoken for/is on the Speaker's Bureau of Amylin Pharmaceuticals, Boehringer Ingelheim, Dexcom, Eli Lilly, Novo Nordisk, and Takeda.