Flexibility in insulin prescription

Kalra, Sanjay; Gupta, Yashdeep; Unnikrishnan, Ambika Gopalakrishnan

doi:10.4103/2230-8210.180003

Cited by 10 publications

(13 citation statements)

References 9 publications

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“…Basal insulin should be injected at the appropriate time (usually bedtime), in line with the prescribing information.Basal insulin may, under some circumstances (e.g., administration by caregivers and nursing home residents), be administered in the morning or afternoon as well, preferably at the same time daily.Basal insulin analogues provide the advantage of flexibility of timing, making it simple and less intrusive. They involve only one injection per day and do not require adherence to inflexible meal patterns, quantity, and composition [25]. Neutral Protamine Hagedorn (NPH) Insulin: With NPH insulin, the preferred injection time is bedtime [26].…”

Section: Be-smart Expert Opinionmentioning

confidence: 99%

BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion

et al. 2019

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The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts—treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring. Funding : Sanofi.

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Section: Be-smart Expert Opinionmentioning

confidence: 99%

BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion

et al. 2019

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“…Further, basal insulin analogues can effectively address glycemic variability by controlling the peaks and troughs of glucose levels. The peaks are addressed by targeting the fasting glucose which in turn minimizes postprandial excursions [ 13 ]. The troughs are addressed as there is lesser risk of hypoglycemia with basal insulin analogues as compared with Neutral Protamine Hagedorn (NPH) insulin and premix or co-formulations [ 14 – 16 ].…”

Section: Review Resultsmentioning

confidence: 99%

Insulinization in T2DM with Basal Analogues During COVID-19 Pandemic: Expert Opinion from an Indian Panel

et al. 2020

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“…Another reason could be insufficient medical management for increasing insulin by the clinician. Clinicians have less experience with premixed insulin than with basal or bolus insulin [ 24 25 26 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in Clinical Outcomes between Patients with and without Hypoglycemia during Hospitalization: A Retrospective Study Using Real-World Evidence

Lee

Kim

et al. 2020

Diabetes Metab J

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Background Some patients admitted to hospitals for glycemic control experience hypoglycemia despite regular meals and despite adhering to standard blood glucose control protocols. Different factors can have a negative impact on blood glucose control and prognosis after discharge. This study investigated risk factors for hypoglycemia and its effects on glycemic control during the hospitalization of patients in the general ward. Methods This retrospective study included patients who were admitted between 2009 and 2018. Patients were provided regular meals at fixed times according to ideal body weights during hospitalization. We categorized the patients into two groups: those with and those without hypoglycemia during hospitalization. Results Of the 3,031 patients, 379 experienced at least one episode of hypoglycemia during hospitalization (HYPO group). Hypoglycemia occurred more frequently particularly in cases of premixed insulin therapy. Compared with the control group, the HYPO group was older (61.0±16.8 years vs. 59.1±16.5 years, P =0.035), with more females (60.4% vs. 49.6%, P <0.001), lower body mass index (BMI) (23.5±4.2 kg/m 2 vs. 25.1±4.4 kg/m 2 , P <0.001), and higher prevalence of type 1 diabetes mellitus (6.1% vs. 2.6%, P <0.001), They had longer hospital stay (11.1±13.5 days vs. 7.6±4.6 days, P <0.001). After discharge the HYPO group had lower glycosylated hemoglobin reduction rate (−2.0%±0.2% vs. −2.5%±0.1%, P =0.003) and tended to have more frequent cases of cardiovascular disease. Conclusion Hypoglycemia occurred more frequently in older female patients with lower BMI and was associated with longer hospital stay and poorer glycemic control after discharge. Therefore, clinicians must carefully ensure that patients do not experience hypoglycemia during hospitalization.

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Flexibility in insulin prescription

Cited by 10 publications

References 9 publications

BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion

BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion

Insulinization in T2DM with Basal Analogues During COVID-19 Pandemic: Expert Opinion from an Indian Panel

Differences in Clinical Outcomes between Patients with and without Hypoglycemia during Hospitalization: A Retrospective Study Using Real-World Evidence

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