Anticipatory guidance in type 2 diabetes to improve disease management; next steps after basal insulin

ABSTRACT

The alarming rise in the number of people living with type 2 diabetes (T2D) presents primary care physicians with increasing challenges associated with long-term chronic disease care. Studies have shown that the majority of patients are not achieving or maintaining glycemic goals, putting them at risk of a wide range of diabetes-related complications. Disease- and self-management programs have been shown to help patients improve their glycemic control, and are likely to be of particular benefit for patients with diabetes dealing with these issues. Anticipatory guidance is an individualized, proactive approach to patient education and counseling by a health-care professional to support patients in better coping with problems before they arise. It has been shown to improve disease outcomes in a variety of chronic conditions, including diabetes. While important at all stages, anticipatory guidance may be of particular importance during changes in treatment regimens, and especially during transition to, and escalation of, insulin-based regimens. The aim of this article is to provide advice to physicians on anticipatory guidance for basal-insulin dosing, focusing on appropriate basal-insulin-dose increase and prevention of potentially deleterious basal-insulin doses, so called overbasalization. It also provides an overview of new treatment options for patients with T2D who are not well controlled on basal-insulin therapy, fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonists, and advice on the type of anticipatory guidance needed to ensure safe and appropriate switching to these therapies.

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KEYWORDS:

• Anticipatory guidance
• basal insulin
• diabetes mellitus type 2
• glycemic goals
• glucagon-like peptide-1 receptor agonists
• hyperglycemia
• patient counseling

Acknowledgments

The authors would like to thank Vanita Aroda, MD for suggesting a review on the concept of anticipatory guidance. The authors received writing/editorial support in the preparation of this manuscript by Michael van der Veer, PhD, of Excerpta Medica, funded by Sanofi US, Inc.

Declaration of interest

EL Johnson serves or has recently served at speakers bureaus for Novo Nordisk and Medtronic; serves or has served on advisory panels for Sanofi and Novo Nordisk. JP Frias serves or has served on advisory panels for AstraZeneca and Sanofi; has received research support from AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, IONIS, Janssen, Johnson & Johnson, Lexicon, Ligand, Merck, Mylan, Novartis AG, Novo Nordisk, Pfizer, Sanofi, Theracos, and vTv Therapeutics. JM Trujillo serves or has served as an advisory board member for Sanofi. 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 no relevant financial relationships or otherwise to disclose.

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Funding

Development of the manuscript was funded by Sanofi US, Inc.