Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes

Sujoy Ghosh; A G Unnikrishnan; Banshi Saboo; Jothydev Kesavadev; S R Aravind; Sarita Bajaj; Rajesh Rajput; Krishna Seshadri; Narsingh Verma; Arvind Gupta; Brij Mohan Makkar; Mihir Saikia; Shailaja Kale; Suresh Damodaran; Ashish Dengra; T K M Eashwar; Anuj Maheshwari; Sharad Pendsey; Sanjeev R Phatak; Surendra Kumar Sharma; Surya Kumar Singh; A Ramachandran; Abdul H Zargar; Shashank R Joshi; Shaukat M Sadikot

doi:10.1016/j.dsx.2017.03.045

Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes

Diabetes Metab Syndr. 2017 Nov:11 Suppl 1:S507-S521. doi: 10.1016/j.dsx.2017.03.045. Epub 2017 Apr 5.

Authors

Sujoy Ghosh¹, A G Unnikrishnan², Banshi Saboo³, Jothydev Kesavadev⁴, S R Aravind⁵, Sarita Bajaj⁶, Rajesh Rajput⁷, Krishna Seshadri⁸, Narsingh Verma⁹, Arvind Gupta¹⁰, Brij Mohan Makkar¹¹, Mihir Saikia¹², Shailaja Kale¹³, Suresh Damodaran¹⁴, Ashish Dengra¹⁵, T K M Eashwar¹⁶, Anuj Maheshwari¹⁷, Sharad Pendsey¹⁸, Sanjeev R Phatak¹⁹, Surendra Kumar Sharma²⁰, Surya Kumar Singh²¹, A Ramachandran²², Abdul H Zargar²³, Shashank R Joshi²⁴, Shaukat M Sadikot²⁵

Affiliations

¹ Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research, Kolkata, India. Electronic address: [email protected].
² Chellaram Diabetes Institute, Pune, India.
³ DiaCare, Ahmedabad, Gujarat, India.
⁴ Jothydev's Diabetes & Research Center, Trivandrum, India.
⁵ Diacon Hospital, Bangalore, India.
⁶ Department of Medicine, Motilal Nehru Medical College, Allahabad, India.
⁷ Department of Endocrinology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India.
⁸ Department of Endocrinology and Metabolism, Shri Rama Chandra University, Chennai, India.
⁹ King George's Medical University, Lucknow, India.
¹⁰ Jaipur Diabetes Research Center, Jaipur, India.
¹¹ Diabetes & Obesity Center, New Delhi, India.
¹² Gauhati Medical College, Guwahati, India.
¹³ Orange Diabetes Foundation, Pune, India.
¹⁴ Consultant Endocrinologist, Coimbatore, India.
¹⁵ Mahi Diabetes & Thyroid Care and Research Center, Jabalpur, India.
¹⁶ Ideas Diabetes Center, Rajkot, India.
¹⁷ Department of Medicine, Babu Banarasi Das University, Lucknow, India.
¹⁸ Diabetes Clinic and Research Center, Nagpur, India.
¹⁹ Sumeru Center, Ahmedabad, India.
²⁰ Galaxy Specialty Center, Jaipur, India.
²¹ Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
²² India Diabetes Research Foundation, Chennai, India.
²³ Advanced Center for Diabetes and Endocrine Care, Srinagar, India.
²⁴ Lilavati and Bhatia Hospital and Grant Medical College, Mumbai, India.
²⁵ Diabetes India, Mumbai, India.

PMID: 28433618
DOI: 10.1016/j.dsx.2017.03.045

Abstract

Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients' exposure to chronic hypo/hyperglycaemia and reduces weight gain while achieving individualized glycaemic targets. This review focuses on the strength of evidence behind various options for intensification, primarily the insulins as also the GLP-1 analogues. The recommendations presented here are meant to serve as a guide for the physician managing type 2 diabetes patients requiring insulin intensification upon failing of basal insulin therapy.

Keywords: Basal plus; GLP-1; Hypoglycaemia; Insulin intensification; Recommendations.

Publication types

Review

MeSH terms

Diabetes Mellitus, Type 2 / drug therapy*
Evidence-Based Medicine
Humans
Hypoglycemic Agents / administration & dosage
Hypoglycemic Agents / therapeutic use*
Insulin / administration & dosage
Insulin / therapeutic use*
Insulin-Secreting Cells / drug effects
Insulin-Secreting Cells / physiology

Substances

Hypoglycemic Agents
Insulin