Basal insulin supported oral therapy in type 2 diabetes
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 5
Abstract
Early intensive glycemic control in type 2 diabetes reduces the risk of long-term complications, and often requires timely initiation and optimization of insulin therapy. While there are several patient and physician-related barriers to early insulin initiation, basal insulin supported oral antidiabetic therapy (BOT) offers an effective, more acceptable and safe way to transition to insulin therapy in type 2 diabetes. Basal insulin, when combined with oral antidiabetic medications with complementary mechanisms of action, targets multiple pathophysiological defects and results in better glycemic control. Another advantage is a reduced risk of side-effects such as hypoglycemia and weight gain, which are associated with more intensive insulin regimens. Basal insulin can be initiated once daily, at a dose of 0.1-0.2 units/kg and the dose can be further titrated based on fasting plasma glucose to achieve a target of 80-130 mg/dl. Oral therapy is individualized based on other factors such as baseline HbA1c, postprandial hyperglycemia, complications and comorbidities, socioeconomic considerations, lifestyle, patient preference and convenience. Further intensification of treatment may be required with addition of bolus insulin or GLP1 receptor agonist or switching to premixed insulin in individuals who are not able to maintain or sustain glycemic control on BOT regimen.
Authors and Affiliations
Gagan Priya
Keywords
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