You may delay, but time will not. Beta cells lost are never found again: a case for timely initiation of basal insulin in type 2 diabetes

Figures & data

Figure 1. Beta-cell modeling suggests that insulin is required approximately 8 years after diagnosis. Used with permission of American Diabetes Association, from insulin secretagogues: old and new, Lebovitz HE, 7, 1999; permission conveyed through copyright clearance center.

Table 1. Recommendations for time in range [57].

		Recommended time each day
Range	Glucose concentration	General population with T2D	Older adults with T2D/ people with T2D at high risk
TIR	70–180 mg/dL	>70% (>16 h 48 min)	>50% (>12 h)
TBR	<70 mg/dL	<4% (<1 h)	<1% (<15 min)
	<54 mg/dL	<1% (15 min)	–
TAR	>180 mg/dL	<25% (6 h)	–
	>250 mg/dL	<5% (1 h 12 min)	<10% (<2 h 24 min)

h, hour; min, minute; T2D, type 2 diabetes; TAR, time above range; TBR, time below range; TIR, time in range.

Figure 2. People with T2D who are candidates for basal insulin. HbA1c, glycated hemoglobin A1C; T2D, type 2 diabetes. ‘Practical guidance on the initiation, titration, and switching of basal insulins: a narrative review for primary care’ by Mehta R, Goldenberg R, Katselnik D, Kuritzky L. Ann Med. 2021;53(1):998–1009 [64] is licensed under CC by 4.1.

Figure 3. Examples of open-ended questions to anticipate barriers to insulin initiation.

Table 2. AT.LANTUS treat-to-target algorithm for basal insulin titration [77].

Starting dose: 10 U/day Target FPG: <100 mg/dL
Instructions: Review FPG patterns in-person or via telephone consultation. Calculate the mean of the last three FPG readings and adjust accordingly.
Mean FPG for previous three days	Daily dose adjustment
≥100 mg/dL and <120 mg/dL	Increase by 0–2 U (at HCP discretion)
≥120 mg/dL and <140 mg/dL	Increase by 2 U
≥140 mg/dL and <180 mg/dL	Increase by 4 U
≥180 mg/dL	Increase by 6–8 U (at HCP discretion)

FPG, fasting plasma glucose; HCP, healthcare professional.

Figure 4. Action steps at different stages of type 2 diabetes.

MDT, multidisciplinary team.

Mehta R, Goldenberg R, Katselnik D, et al. Practical guidance on the initiation, titration, and switching of basal insulins: a narrative review for primary care. Ann Med. 2021;53(1):998–1010. 10.1080/07853890.2021.1925148

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Davies M, Storms F, Shutler S, et al. Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. Diabetes Care. 2005;28(6):1282–1288. doi: 10.2337/diacare.28.6.1282

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