Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy

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

doi:10.2337/dc08-9025

Cited by 3,106 publications

(2,506 citation statements)

References 94 publications

Supporting

Mentioning

2,348

Contrasting

Unclassified

Order By: Relevance

“…According to the ADA guideline and ADA/EASD consensus statement19, 40, in general, HbA1c goal should be achieved and sustained at the level of <7%, and insulin could be initiated when HbA1c is not at goal. However, the present results showed that insulin therapy in Taiwan was delayed.…”

Section: Discussionmentioning

confidence: 99%

“…The statement of the American Diabetes Association and the European Association for the Study of Diabetes (ADA/EASD) emphasized the importance of the timely addition of basal insulin in patients with type 2 diabetes after OAD18, 19. The clinical trials showed that the use of basal insulin as an add‐on to OAD in patients with type 2 diabetes achieved 7% HbA1c, and approximately half of the patients experienced symptomatic hypoglycemia20, 21, 22, 23, 24.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Chien

Chen²,

Hung

et al. 2016

J of Diabetes Invest

View full text Add to dashboard Cite

Aims/IntroductionThe aim of the present study was to assess the glycemic control, adherence and treatment satisfaction in a real‐world setting with basal insulin therapy in type 2 diabetes patients in Taiwan.Materials and MethodsThis was a multicenter, prospective, observational registry. A total of 836 patients with type 2 diabetes taking oral antidiabetic drugs with glycated hemoglobin (HbA1c) >7% entered the study. Basal insulin was given for 24 weeks. All treatment choices and medical instructions were at the physician's discretion to reflect real‐life practice.ResultsAfter 24‐week treatment, 11.7% of patients reached set HbA1c goals without severe hypoglycemia (primary effectiveness end‐point). HbA1c and fasting blood glucose were significantly decreased from (mean ± SD) 10.1 ± 1.9% to 8.7 ± 1.7% (−1.4 ± 2.1%, P < 0.0001) and from 230.6 ± 68.8 mg/dL to 159.1 ± 55.6 mg/dL (−67.4 ± 72.3 mg/dL, P < 0.0001), respectively. Patients received insulin therapy at a frequency of nearly one shot per day on average, whereas self‐monitoring of blood glucose was carried out approximately four times a week. Hypoglycemia was reported by 11.4% of patients, and only 0.7% of patients experienced severe hypoglycemia. Slight changes in weight (0.7 ± 2.4 kg) and a low incidence of adverse drug reactions (0.4%) were also noted. The score of 7‐point treatment satisfaction rated by patients was significantly improved by 1.9 ± 1.7 (P < 0.0001).ConclusionsBasal insulin therapy was associated with a decrease in HbA1c and fasting blood glucose, and an improved treatment satisfaction. Most patients complied with physicians' instructions. The treatment was generally well tolerated by patients with type 2 diabetes, but findings pointed out the need to reinforce the early and appropriate uptitration to achieve treatment targets.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Chien

Chen²,

Hung

et al. 2016

J of Diabetes Invest

View full text Add to dashboard Cite

show abstract

“…Insulin therapy, the most effective treatment for lowering blood glucose 1, comes with the attendant risk of hypoglycaemia, which may prevent people with diabetes from achieving glycaemic control 2, 3. Position statements from the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) recommend a patient‐centred approach with individualized glycaemic targets to minimize hypoglycaemia 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Regional variations in definitions and rates of hypoglycaemia: findings from the global HAT observational study of 27 585 people with Type 1 and insulin‐treated Type 2 diabetes mellitus

et al. 2018

View full text Add to dashboard Cite

AimTo determine participant knowledge and reporting of hypoglycaemia in the non‐interventional Hypoglycaemia Assessment Tool (HAT) study.Methods HAT was conducted in 24 countries over a 6‐month retrospective/4‐week prospective period in 27 585 adults with Type 1 or insulin‐treated Type 2 diabetes mellitus. Participants recorded whether hypoglycaemia was based on blood glucose levels, symptoms or both.ResultsHypoglycaemia rates were consistently higher in the prospective compared with the retrospective period. Most respondents (96.8% Type 1 diabetes; 85.6% Type 2 diabetes) knew the American Diabetes Association/European Association for the Study of Diabetes hypoglycaemia definition, but there were regional differences in the use of blood glucose measurements and/or symptoms to define events. Confirmed symptomatic hypoglycaemia rates were highest in Northern Europe/Canada for Type 1 diabetes (63.9 events/year) and in Eastern Europe for Type 2 diabetes (19.4 events/year), and lowest in South East Asia (Type 1 diabetes: 6.0 events/year; Type 2 diabetes: 3.2 events/year). Unconfirmed symptomatic hypoglycaemia rates were highest in Eastern Europe for Type 1 diabetes (5.6 events/year) and South East Asia for Type 2 diabetes (4.7 events/year), and lowest for both in Russia (Type 1 diabetes: 2.1 events/year; Type 2 diabetes: 0.4 events/year). Participants in Latin America reported the highest rates of severe hypoglycaemia (Type 1 diabetes: 10.8 events/year; Type 2 diabetes 3.7 events/year) and severe hypoglycaemia requiring hospitalization (Type 1 diabetes: 0.56 events/year; Type 2 diabetes: 0.44 events/year). The lowest rates of severe hypoglycaemia were reported in South East Asia (Type 1 diabetes: 2.0 events/year) and Northern Europe/Canada (Type 2 diabetes: 1.3 events/year), and the lowest rates of severe hypoglycaemia requiring hospitalization were in Russia (Type 1 diabetes: 0.15 events/year; Type 2 diabetes: 0.09 events/year). The blood glucose cut‐off used to define hypoglycaemia varied between regions (Type 1 diabetes: 3.1–3.6 mmol/l; Type 2 diabetes: 3.5–3.8 mmol/l).ConclusionsUnder‐reporting of hypoglycaemia rates in retrospective recall and regional variations in participant definitions of hypoglycaemia may contribute to the global differences in reported rates. Discrepancies between participant definitions and guidelines may highlight a need to redefine hypoglycaemia criteria. (Clinical Trials Registry No: NCT01696266).

show abstract

“…Basal insulin‐supported oral therapy (BOT) is commonly used to initiate insulin therapy when oral hypoglycemic agents (OHA) do not achieve adequate glycemic control in patients with type 2 diabetes1, 2. It involves the addition of once‐daily long‐acting insulin, such as insulin glargine or insulin degludec, to ongoing OHA therapy.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of switching from basal insulin to once‐daily insulin degludec/insulin aspart in Japanese patients with inadequately controlled type 2 diabetes: A 4‐week, randomized, open‐label, treat‐to‐target study

Nagai

Nishine

Hashimoto

et al. 2017

J of Diabetes Invest

View full text Add to dashboard Cite

Aims/IntroductionA prospective, 4‐week, single‐center, randomized, open‐label, parallel‐group, treat‐to‐target study was carried out to develop an algorithm for safe and effective switching from basal insulin to once‐daily insulin degludec/insulin aspart (IDegAsp) in patients with inadequately controlled type 2 diabetes.Materials and MethodsPatients were randomly assigned to continue their current basal insulin therapy (n = 10) or to switch to IDegAsp on a 1:1 unit basis (n = 10). The insulin dose could be titrated once weekly, targeting a self‐measured blood glucose of 80–100 mg/dL before breakfast. A mixed meal test was carried out at baseline and after 4 weeks.ResultsAfter 4 weeks, the mean daily dose of insulin was similarly increased by 60% in both groups, and there was a significant decrease of mean plasma glucose and glucose area under the glucose concentration vs time curve for 2 h in the meal test. The mean estimated treatment difference (IDegAsp group − basal insulin group) of the mean plasma glucose level was −28 mg/dL (95% confidence interval −47 to −8, P = 0.008) after 4 weeks and that of the area under the glucose concentration vs time curve for 2 h was −2,800 mg/min/dL (95% confidence interval −5,300 to −350, P = 0.028), confirming the superiority of IDegAsp to basal insulin. In the IDegAsp group, the 2‐h postprandial plasma glucose level was significantly decreased to the fasting plasma glucose range. There were no confirmed hypoglycemic episodes in either group during the 4‐week study period.ConclusionsAfter switching from basal insulin, the IDegAsp dose can be uptitrated by 60% based on fasting plasma glucose data. However, monitoring of postprandial glucose should be considered before further uptitration of IDegAsp.

show abstract

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy

Cited by 3,106 publications

References 94 publications

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Regional variations in definitions and rates of hypoglycaemia: findings from the global HAT observational study of 27 585 people with Type 1 and insulin‐treated Type 2 diabetes mellitus

Efficacy and safety of switching from basal insulin to once‐daily insulin degludec/insulin aspart in Japanese patients with inadequately controlled type 2 diabetes: A 4‐week, randomized, open‐label, treat‐to‐target study

Contact Info

Product

Resources

About