Options for prandial glucose management in type 2 diabetes patients using basal insulin: Addition of a short-acting GLP-1 analogue versus progression to basal-bolus therapy

I. B. Hirsch, J. B. Buse, J. Leahy, J. B. Mcgill, A. Peters, H. W. Rodbard, R. R. Rubin, J. S. Skyler, C. A. Verderese, M. C. Riddle

Research output: Contribution to journalReview article

7 Scopus citations

Abstract

Integrating patient-centered diabetes care and algorithmic medicine poses particular challenges when optimized basal insulin fails to maintain glycaemic control in patients with type 2 diabetes. Multiple entwined physiological, psychosocial and systems barriers to insulin adherence are not easily studied and are not adequately considered in most treatment algorithms. Moreover, the limited number of alternatives to add-on prandial insulin therapy has hindered shared decision-making, a central feature of patient-centered care. This article considers how the addition of a glucagon-like peptide 1 (GLP-1) analogue to basal insulin may provide new opportunities at this stage of treatment, especially for patients concerned about weight gain and risk of hypoglycaemia. A flexible framework for patient-clinician discussions is presented to encourage development of decision-support tools applicable to both specialty and primary care practice.

Original languageEnglish (US)
Pages (from-to)206-214
Number of pages9
JournalDiabetes, Obesity and Metabolism
Volume16
Issue number3
DOIs
StatePublished - Mar 2014

Keywords

  • GLP-1 analogue
  • Insulin analogues
  • Insulin intensive management

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

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