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Personalized intensification of insulin therapy in type 2 diabetes – does a basal–bolus regimen suit all patients?
Personalized intensification of insulin therapy in type 2 diabetes – does a basal–bolus regimen suit all patients?
- Source :
- Current Medical Research and Opinion. 32:1425-1434
- Publication Year :
- 2016
- Publisher :
- Informa UK Limited, 2016.
-
Abstract
- Many patients with type 2 diabetes mellitus (T2DM) require insulin therapy. If basal insulin fails to achieve glycemic control, insulin intensification is one possible treatment intensification strategy. We summarized clinical data from randomized clinical trials designed to compare the efficacy and safety of basal-bolus and premixed insulin intensification regimens. We defined a between-group difference of ≥0.3% in end-of-study glycated hemoglobin (HbA1c) as clinically meaningful. A PubMed database search supplemented by author-identified papers yielded 15 trials which met selection criteria: randomized design, patients with T2DM receiving basal-bolus (bolus injection ≤3 times/day) vs. premixed (≤3 injections/day) insulin regimens, primary/major endpoint(s) HbA1c- and/or hypoglycemia-related, and trial duration ≥12 weeks. Glycemic control improved with both basal-bolus and premixed insulin regimens with - in most cases - acceptable levels of weight gain and hypoglycemia. A clinically meaningful difference between regimens in glycemic control was recorded in only four comparisons, all of which favored basal-bolus therapy. The incidence of hypoglycemia was significantly different between regimens in only three comparisons, one of which favored premixed insulin and two basal-bolus therapy. Of the four trials that reported a significant difference between regimens in bodyweight change, two favored basal-bolus therapy and two favored premixed insulin. Thus, on a population level, neither basal-bolus therapy nor premixed insulin showed a consistent advantage in terms of glycemic control, hypoglycemic risk, or bodyweight gain. It is therefore recommended that clinicians should adopt an individualized approach to insulin intensification - taking into account the benefits and risks of each treatment approach and the attitude and preferences of each patient - in the knowledge that both basal-bolus and premixed regimens may be successful.
- Subjects :
- Blood Glucose
medicine.medical_specialty
medicine.medical_treatment
030209 endocrinology & metabolism
Type 2 diabetes
030204 cardiovascular system & hematology
Hypoglycemia
Weight Gain
law.invention
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
medicine
Humans
Hypoglycemic Agents
Insulin
Precision Medicine
Glycemic
Glycated Hemoglobin
business.industry
Type 2 Diabetes Mellitus
General Medicine
medicine.disease
Surgery
Regimen
Diabetes Mellitus, Type 2
chemistry
Glycated hemoglobin
business
Subjects
Details
- ISSN :
- 14734877 and 03007995
- Volume :
- 32
- Database :
- OpenAIRE
- Journal :
- Current Medical Research and Opinion
- Accession number :
- edsair.doi.dedup.....53b513847059df4d906b1724fc8c063b
- Full Text :
- https://doi.org/10.1080/03007995.2016.1181051