Assess the differences in incretinbased therapies for the treatment of type 2 diabetes mellitus t2dm. Psap 20 ewharmrcoethrpwatrmrco 5 new pharmacotherapies for type 2 diabetes learning objectives 1. Insulin therapy for type 2 diabetes are we there yet. Insulin therapy in type insulin therapy in type 2 insulin therapy in type 2 diabetes. Insulin therapy in type 2 diabetes touchendocrinology. Indications for exogenous insulin therapy in patients with type 2 diabetes mellitus t2dm include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy b. Individuals with type 2 diabetes initially are treated with lifestyle changes including diet and exercise,1, 2, 3 but treatment intensification because of declining betacell function usually is required and blood glucose may become inadequately controlled with oral glucoselowering. A brief overview of diabetes and the american diabetes association. Longacting insulin analogues versus nph human insulin in type 2 diabetes. Insulin therapy for adult patients with type 2 diabetes mellitus.
When lifestyle modifications and treatment with metformin with or without other oral antidiabetic drugs oads have failed to achieve normoglycemia, timely initiation of singledose basal insulin treatment is a convenient, effective, and recommended strategy. A add basal insulin to oral medications as soon as needed to help patients reach fasting glycemic goals. Type 2 diabetes mellitus is a progressive disease in which. Diabetes due to diseases of the exocrine pancreas pancreatitis, pancreatectomy, or pancreatic adenocarcinoma cystic fibrosis hemochromatosis others diabetes due to other endocrinopathies acromegaly cushings syndrome pheochromocytoma glucagonoma others monogenic forms of diabetes. This case study is the first, so far, to use outpatient intensive insulin therapy as the primary treatment for type 2 diabetes. Outline a plan for addressing adverse effects and safety issues in insulintreated patients. While insulin therapy is required from the onset of diagnosis in type 1 disease, its role in type 2 diabetes requires consideration. Currently no pharmacologic regimen has proved superior for. Insulin replacement therapy is mostly used by patients with type 2 diabetes who become insulin deficient and have failed other therapeutic options. Insulin therapy in type 2 diabetes mellitus insulin therapy is initiated for patients early in their course of diabetes to relieve symptoms of severe hyperglycaemia or in the hope of achieving remission and during the course of diabetes to attain optimal control. This drug is not recommended for use in conjunction with mealtime bolus insulin therapy. Insulin therapy in type 2 diabetes initiation, impact on liver fat, role of combination therapy with glitazones or glinides leena juurinen academic dissertation to be presented with the permission of the faculty of medicine of the university of helsinki, for public examination in lecture hall 4, university hospital helsinki, haartmanninkatu 4. The identification and rating of the body of evidence to support the type 2 diabetes insulin guidelines followed a threestep process.
Insulin management of type 2 diabetes mellitus aafp. Medical treatment requires initial therapy with metformin, or other oral glucoselowering agents, including. Insulin therapy for type 2 diabetes pubmed central pmc. Since the discovery of insulin, it was the only drug available for the treatment of diabetes until the development of sulfonylureas and biguanides 50 years later. Insulin therapy in type 2 diabetes mellitus uptodate. They comprise about a quarter of those with diabetes, endures the majority of the complications and consumes the majority of the resources. An increasing body of evidence suggests that early intensive glycemic control reduces longterm vascular outcomes and potentially may prolong bbeta symbolcell lifespan and function. Transdermal insulin skin patch delivery has also yielded disappointing results to date. Diet control and exercise is mandatory to improve glycemic control in type 2 diabetes mellitus. Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial a1c level greater than. Exogenous insulin is well established as the primary and lifesaving therapy for type 1 diabetes. A position statement of the korean diabetes association, 2017. Insulin in pill form is also not yet effective since the digestive enzymes in the gut break it down.
Guillermo umpierrez, md, facp, face professor of medicine emory university school of medicine external industry relationships company names role equity, stock, or. Outline a plan for addressing adverse effects and safety issues in insulin treated patients. Learn when your doctor might recommend insulin, and how to take it to avoid diabetes complications. Type 2 diabetes most people with diabetes have type 2 most people are over age 40 when diagnosed, but type 2 is becoming more common younger adults, children and teens type 2 is more likely in people who. The potential shortterm benefits are not limited to lowering hyperglycemia, but also include reducing free fatty acid levels, lipid levels, and endogenous glucose production. Consider the benefits and understand the commitment. Compare and contrast the differences between the drug therapy recommendations of several of the lat est and leading diabetes guidelines. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy. Decline of insulin therapy recommendations was identified using natural language processing of provider notes. In todays global marketthe global marketplace of today, the world wide web is an essential portion of the strategies of almost any small business. There is much variation in cost, even within drug classes. We retrospectively studied adults with type 2 diabetes and suboptimal hba 1c. How to use adas type 2 diabetes treatment algorithm carlos mendez, md, facp presenter disclosure information in compliance with the accrediting board policies, the american diabetes association requires the following disclosure to the participants.
Insulin therapy is a critical part of treatment for people with type 1 diabetes and also for many with type 2 diabetes. This article discusses the role of insulin therapy in patients with type 2. Because insulin therapy frequently leads to weight gain, it would be expected that this increase in. Therefore,therationaleforimitating the insulin secretion pattern of human physiology is less convincing than in type 1 diabetes. This aggressive therapy isnt easy, but the benefits are real. Insulin cannot be taken as a pill because it would be broken down during digestion just like the protein in food.
The goal of insulin therapy is to keep your blood sugar levels within a target range. Usually, drug therapy for type 2 diabetes is focused on helping a body produce more insulin or on making the body more sensitive to the insulin produced. Insulin therapy would be initiated if a stressed pancreas is not be able to keep up with glucose demands. Predictors and consequences of declining insulin therapy.
Insulin is usually injected in the fat under your skin using a syringe, insulin pen or insulin pump tubing. Mcfarlane, md, mph the potential for insulinrelated weight gain in patients with type 2 diabetes presents a therapeutic dilemma and frequently leads to delays in the initiation of insulin therapy. Apr 10, 2018 insulin replacement therapy is mostly used by patients with type 2 diabetes who become insulin deficient and have failed other therapeutic options. Patients with type 2 diabetes mellitus are usually treated initially with oral antidiabetic agents, but as the disease progresses, most patients eventually require insulin to maintain glucose control. Insulin therapy in type 2 diabetes mellitus cecity. Insulin therapy in type 2 diabetes combination oral agents plus basal insulin bbedtimeedtime nphnph glargine detemir insulin therapy conventional approach splitmixed nph plus regular insulin mdi multidose insulin protocols basalbolus insulin therapy basal insulin therapybasal insulin therapy concept and. Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial a1c level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Individuals with type 2 diabetes initially are treated with lifestyle changes including diet and exercise,1, 2, 3 but treatment intensification because of declining betacell function usually is required and blood glucose may become inadequately controlled with oral glucoselowering treatments or. Basal insulin therapy in type 2 diabetes american board of. Dec 03, 2017 diabetes mellitus, also known as sugar in layman language is a disease in which the bodys ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood insulin therapy is the mainstay of treatment in type 1 diabetes mellitus. The type of malignancy which seems to be more closely associated with insulin therapy in patients with type 2 diabetes is pancreatic cancer.
Aug 10, 2016 usually, drug therapy for type 2 diabetes is focused on helping a body produce more insulin or on making the body more sensitive to the insulin produced. If you have type 1 diabetes and in some cases if you have type 2 diabetes intensive insulin therapy may be the key to longterm health. Early and aggressive initiation of insulin therapy for. Predictors and consequences of declining insulin therapy by. Insulin titration every 2 3 days to reach glycemic goal. Use of insulin therapy in managing type 2 diabetes mellitus. Indeed, in patients with type 2 diabetes, the rapidacting analogs were not found to be superior to regular.
Many patients are reticent about initiating insulin, so therapies that allow insulin treatment to be more tailored to individual. Ultimately, the goal in the management of type 1 diabetes is to provide insulin therapy in a manner that mimics the natural pancreas. One or two doses of nph insulin, or one dose of a basal analogue. People with type 2 diabetes make insulin, but their bodies dont respond well to it. Insulin therapy in people with type 2 diabetes diabetes care. Whereas there is consensus on the need for insulin, controversy exists on how to initiate and. Use of insulin therapy in managing type 2 diabetes mellitus continuing pharmacy education. A number of landmark randomized clinical trials established that insulin therapy reduces microvascular complications 1, 2. Inform patients with type 2 diabetes about the possible need for insulin therapy if diet, healthy lifestyle, and medications other than insulin do not achieve glycemic control. Adequate insulin replacement therapy can prevent complications and reduce expenses, as long as therapy goals. Starting insulin therapy in type 2 diabetes online made easy. In addition to timely initiation, rapid titration of the dose is indispensable for successful insulin therapy. When lifestyle modifications and treatment with metformin with or without other oral antidiabetic drugs oads have failed to achieve normoglycemia, timely initiation of singledose basal insulin treatment is a convenient, effective, and recommended. Insulin therapy is the only option for type 1 diabetes.
Pdf on jan 1, 2011, hussein zanariah and others published practical guide to insulin therapy in type 2 diabetes find, read and cite all the research you need on researchgate. Insulin may be prescribed in many different ways for the treatment of type 2 diabetes it depends on the needs of the individual person. This drug is not recommended for use in conjunction with additional basal insulin therapy. Compare common options for insulin therapy mayo clinic. A practical approach for primary care physicians and other health care professionals you will receive an email whenever this article is corrected, updated, or cited in the literature. Adobe acrobat reader version 7 or above to view pdf files if you do not have. Benefits of insulin therapy in type 2 diabetes improvement in insulin sensitivity as already discussed, insulin resistance is a major pathophysiologic abnormality in type 2 diabetes. Early insulin therapy in patients with type 2 diabetes. Consider insulin as initial therapy if a1c very high, such as 10. Intensive insulin therapy as the primary treatment for type 2. The insulin may be given once a day, many times a day, or even via an insulin pump. Specific clinical indications for use of insulin therapy in type 2 diabetes, as well as appropriate regimens, are summarized in table 4. If patient unable to do multiple daily injections, consider switching to mixed insulin instead of adding prandial insulin.
Insulin is a polypeptide hormone secreted by pancreatic betacells. It also sometimes is given to people with prediabetes and type 2 diabetes in the hospital. Insulin therapy for type 2 diabetes mellitus clinical. Early insulin therapy in patients with type 2 diabetes mellitus. If further adjustments are needed, add prandial insulin. Early and aggressive initiation of insulin therapy for type 2. Consensus on insulin treatment in type 2 diabetes endocrinologia. Treatment of type 2 diabetes insulin therapy diabetes. The authors correctly point out that therapeutic inertia is a major barrier, and for insulin treatment, divide it into three phases, initiation inertia, titration inertia the first 8. Intensive insulin therapy can help prevent longterm diabetes complications. Strategies for early combination therapy for type 2.
It also poses considerable challenges when treatment is intensi. An increasing body of evidence suggests that early intensive glycemic control reduces longterm vascular outcomes and potentially may prolong. Prospective diabetes study ukpds suggest that early insulin treatment also lowers macrovascular risk in type 2 diabetes 3. Explain the role of insulin in managing type 2 diabetes mellitus taking into account current treatment guidelines and available insulin products. Pdf practical guide to insulin therapy in type 2 diabetes. Pancreas makes too little or no insulin type 1 diabetes type 2 diabetes cells do not use insulin well insulin resistance. Increase prandial dose by 10 or 12 units if 2h postprandial or net premeal glucose consistently 140 mgdl if hypoglycemia reduce tdd basal andor prandial insulin by bg consistently 0 mgdl 10 20 severe hypoglycemia reuiring assistance from another. Due to the progressive nature of type 2 diabetes, insulin therapy is often required to achieve glycemic control. Jul 27, 2019 insulin therapy is a critical part of treatment for people with type 1 diabetes and also for many with type 2 diabetes. Optimal insulin therapy should mimic the normal physiologic secretion of insulin and minimize the risk of hypoglycemia. Type 2 diabetes is a progressive disease in which bbeta symbolcell function continually declines and eventually fails, ultimately requiring nearly all patients to be placed on insulin therapy. Insulin is an effective treatment for achieving tight glycemic control and improving clinical outcomes in patients with diabetes. Xx insulin therapy in type 2 diabetes mellitus insulin therapy is initiated for patients early in their course of diabetes to relieve symptoms of severe hyperglycaemia or in the hope of achieving remission and during the course of diabetes to attain optimal control.
How to use adas type 2 diabetes treatment algorithm. Since the discovery of insulin, it was the only drug available for the treatment of di. But even with the availability of oral glucoselowering drugs, insulin supplementation was often needed to achieve good glucose control in type 2 diabetes. New developments in insulin therapy for type 2 diabetes. The preferred regimen for insulin initiation in type 2 diabetes is oncedaily basal insulin. Adequate insulin replacement therapy can prevent complications and reduce. Lasalle, do rachele berria, md, phd the responsibility of diabetes management and insulin therapy has definitively moved to primary care physicians. Type 2 diabetes is by far the most common type of diabetes in adults and is characterized by hyperglycemia and variable degrees of insulin. Basal insulin therapy in type 2 diabetes american board. Mar 19, 2020 intensive insulin therapy can help prevent longterm diabetes complications. Hypoglycemia risk is very low among type 2 diabetic patients just starting insulin therapy, making nph insulin the most costeffective drug. A practical approach for primary care physicians and other health care professionals james r. Are overweight are noncaucasian have a family history of type 2. Practice recommendations inform patients with type 2 diabetes about the possible need for insulin therapy if diet, healthy lifestyle, and medications other than insulin do not achieve glycemic control.