The importance of the initial period of basal insulin titration in people with diabetes
Khunti, Kamlesh (University of Leicester)
Giorgino, Francesco (University of Bari Aldo Moro)
Berard, Lori (Winnipeg Regional Health Authority)
Mauricio Puente, Dídac (Institut d'Investigació Biomèdica Sant Pau)
Harris, Stewart B. (Western University)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	Achieving target glycaemic control is essential in people with diabetes to minimize the risk of long-term complications, and many people with type 2 diabetes will ultimately require basal insulin (BI) therapy to achieve their individualized glycaemic targets. Usually, the first 12 weeks following initiation of BI therapy represents the period when the greatest dose increases and glycaemic reductions occur. Effective glycaemic control combined with minimizing the risk of hypoglycaemia is important to enable the achievement of glycaemic control in the longer term. However, substantial therapeutic inertia exists in clinical practice, both in initiation and up-titration of BI, owing to patient-, physician- and healthcare system-related barriers, including fear of hypoglycaemia and the perception of a burdensome regimen. The more prolonged duration of action, reduced glycaemic variability and lower risk of hypoglycaemia seen with second-generation versus first-generation BI analogues may help alleviate patients' and physicians' concerns and facilitate titration. In turn, optimal BI titration and subsequent metabolic benefits may help improve therapy adherence and self-management. This review details the clinical implications of prompt titration of BI to achieve early glycaemic control, and the importance of minimizing hypoglycaemia risk within the initial titration period. Facilitation of patients' self-management of BI is also addressed.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Basal insulin ; Glycaemic control ; Hypoglycaemia ; Insulin analogues ; Insulin therapy
Publicat a:	Diabetes, Obesity and Metabolism, Vol. 22 Núm. 5 (january 2020) , p. 722-733, ISSN 1463-1326

DOI: 10.1111/dom.13946
PMID: 31865632

12 p, 1.0 MB

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