Management of Type 2 Diabetes Mellitus with Basal-Prandial Insulin Therapy: A Case-Based Review |
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| Institution: | 1. Yale School of Medicine, New Haven, CT, United States;2. Brigham and Women''s Hospital, Boston, MA, United States;3. UMass Medical School, Worcester, MA, United States;4. Massachusetts General Hospital, Boston, MA, United States;5. Boston University, Boston, MA, United States;6. Lahey Clinic, Burlington, MA, United States;7. Beth Israel Deaconess Medical Center, Boston, MA, United States;1. Carver College of Medicine, University of Iowa, Iowa City, IA, United States;2. College of Public Health, Department of Epidemiology; Carver College of Medicine, Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States;3. Stead Family Children''s Hospital, Department of Surgery, Division of Pediatric Surgery, University of Iowa, Iowa City, IA, United States;4. College of Public Health, Department of Epidemiology; Carver College of Medicine, Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States;5. College of Public Health, Department of Epidemiology, Carver College of Medicine, Department of Emergency Medicine; Department of Anesthesia Critical Care, University of Iowa, Iowa City, IA, United States |
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| Abstract: | Background: Diabetes mellitus (DM) is a growing epidemic in the United States—20.8 million people are affected and 90% to 95% of all diagnosed cases are type 2 DM. Nevertheless, implementation of insulin therapy is often delayed in patients with type 2 DM. This delay can increase the risk of DM-related complications, including microvascular neuropathy, nephropathy, retinopathy, and cardiovascular disease.Objective: This article provides a case-based review outlining a novel strategy for advancing therapy with a modified basal and prandial insulin regimen to achieve recommended glycemic targets in type 2 DM as quickly as possible. Evidence-based treatment strategies are also discussed.Methods: Materials used for this article were identified through an English-language literature search of MEDLINE (1967-2007) using the following terms: insulin, postprandial glucose control, and type 2 diabetes.Results: As shown with this male 46-year-old case study patient, type 2 DM is treated initially with diet and exercise, followed by oral antidiabetic drugs (OADs). However, oral therapy typically reduces glycosylated hemoglobin values only by -1.5% to 2.0%. Intensive therapy with once-daily basal insulin in combination with a previously prescribed OAD regimen can achieve normoglycemia and reduce the long-term complications of DM. In patients with postprandial glucose excursions, prandial insulin can be added using a rapid-acting insulin analogue (aspart, lispro, or glulisine).Conclusions: A key factor in this case patient's ability to reach glycemic targets within I year of diagnosis of type 2 DM was the accelerated implementation of insulin therapy. Such a therapeutic approach obviates the risk for uncontrolled hyperglycemia, which is associated with the standard practice of beginning treatment with diet and exercise alone and slowly advancing by i OAD at a time, ending with insulin therapy as a last resort. (Insulin. 2007;2:118-126) |
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