Switching basal insulins in type 2 diabetes: practical recommendations for health care providers

ABSTRACT

Basal insulin remains the mainstay of treatment of type 2 diabetes when diet changes and exercise in combination with oral drugs and other injectable agents are not sufficient to control hyperglycemia. Insulin therapy should be individualized, and several factors influence the choice of basal insulin; these include pharmacological properties, patient preferences, and lifestyle, as well as health insurance plan formularies. The recent availability of basal insulin formulations with longer durations of action has provided further dosing flexibility; however, patients may need to switch agents throughout therapy for a variety of personal, clinical, or economic reasons. Although a unit-to-unit switching approach is usually recommended, this conversion strategy may not be appropriate for all patients and types of insulin. Glycemic control and risk of hypoglycemia must be closely monitored by health care providers during the switching process. In addition, individual changes in care and formulary coverage need to be adequately addressed in order to enable a smooth transition with optimal outcomes.

KEYWORDS:

• Type 2 diabetes
• basal insulin therapy
• basal insulin switching
• practical recommendations
• economical aspects

Acknowledgments

The authors received writing/editorial support in the preparation of this manuscript provided by Patricia Fonseca, PhD, of Excerpta Medica, funded by Sanofi US, Inc.

Declaration of interest

SL Anderson reports no conflicts of interest. JM Trujillo has participated in advisory boards for Sanofi. JE Anderson has participated in advisory boards for AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck & Co., and Sanofi, and is a member of the speakers’ bureaus of AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Janssen, and Sanofi. RJ Tanenberg has received research support from Novo Nordisk and Sanofi, and has participated in advisory boards for Monarch Medical and InSpark Technologies. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have received an honorarium from PGM for their review work, but have no other relevant financial relationships to disclose.

Supplemental Material

Supplemental data for this article can be accessed here.

Additional information

Funding

Sanofi US, Inc..