Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy

Nathan, David M.; Buse, John B.; Davidson, Mayer B.; Heine, Robert J.; Holman, Rury R.; Sherwin, Robert S.; Zinman, Bernard

doi:10.1007/s00125-006-0316-2

Cited by 388 publications

(152 citation statements)

References 72 publications

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“…[1][2][3][4]32 Insulin is usually used as the last option in the management of T2DM. 32 Delay in insulin initiation is the common cause of prolonged exposure to hyperglycaemia, which results in diabetes-related complications.…”

Section: Resultsmentioning

confidence: 99%

“…4,9,10,[20][21][22] Insulin is also considered in patients on maximum oral hypoglycaemic agents with individualised glycaemic target unmet. [10][11][12][20][21][22] …”

Section: Indications For Early Insulin Therapy In T2dmmentioning

confidence: 99%

“…1 Glycaemic control is important in the management of T2DM to prevent diabetes-related complications. [1][2][3][4] Early in the onset of T2DM there is development of relative insulin deficiency and, later, absolute insulin deficiency. 1 Therefore, when a patient is diagnosed with T2DM, the degree of deficiency depends on the stage of the disease at which the diagnosis has been made.…”

Section: Introductionmentioning

confidence: 99%

“…8,12,13 Insulin is the only drug with an unlimited percentage of HbA1c reduction. 4 Doses of insulin can be titrated until an individualised glycaemic target is reached. 4 It is, therefore, important for clinicians to understand the importance of early insulin initiation so that glycaemic control can be achieved early and consequently prevent diabetesrelated complications.…”

Section: Introductionmentioning

confidence: 99%

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Early insulin therapy in patients with type 2 diabetes mellitus

Mashitisho

2016

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Type 2 diabetes mellitus (T2DM) is a progressive disease characterised by beta cell dysfunction and insulin resistance. Beta cell dysfunction progresses to beta cell failure. Many patients with T2DM are managed with oral agents until complications develop. 'Clinical inertia' in T2DM, defined as lack of initiation or intensification of therapy when clinically indicated, is common among clinicians. Patients are exposed to hyperglycaemia for a long time resulting in glucotoxicity to beta cells, leading to further beta cell deterioration. The traditional approach to the management of T2DM is lifestyle change, diet, exercise, weight loss, oral agents and, lastly, insulin. This traditional approach is usually carried out step-by-step and at a slow pace, with insulin offered as a last option. By the time insulin therapy is initiated, complications have already developed. It is, therefore, important for clinicians to be aware of the importance of initiating insulin therapy early to prevent poor glycaemic control and the development of diabetes-related complications.

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Section: Resultsmentioning

confidence: 99%

“…4,9,10,[20][21][22] Insulin is also considered in patients on maximum oral hypoglycaemic agents with individualised glycaemic target unmet. [10][11][12][20][21][22] …”

Section: Indications For Early Insulin Therapy In T2dmmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early insulin therapy in patients with type 2 diabetes mellitus

Mashitisho

2016

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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“…Therefore, we know few studies that examined the antihyperglycemic effect of metformin at doses greater than 750 mg/day in Japanese patients with newly diagnosed type 2 diabetes. The American Diabetes Association (ADA) and the European Society for the Study of Diabetes (EASD) issued a consensus algorithm for the initial management of hyperglycemia in patients with type 2 diabetes in 2006 (9) and updated it in 2009 (10), where the standard dose of metformin ("1,500 mg/ day) (11) and lifestyle interventions is recommended as an initial treatment in patients with newly diagnosed type 2 diabetes. We are, however, aware of no published report that describes the effectiveness of this approach in Japanese patients with type 2 diabetes.…”

Section: Effectiveness Of Metformin and Lifestyle Interventions Asmentioning

confidence: 99%