PMID- 18577159
OWN - NLM
STAT- MEDLINE
DCOM- 20090402
LR  - 20221207
IS  - 1463-1326 (Electronic)
IS  - 1462-8902 (Linking)
VI  - 10 Suppl 2
DP  - 2008 Jul
TI  - Options for the intensification of insulin therapy when basal insulin is not 
      enough in type 2 diabetes mellitus.
PG  - 76-82
LID - 10.1111/j.1463-1326.2008.00846.x [doi]
AB  - In the early treatment of type 2 diabetes mellitus (T2DM), the addition of a 
      basal insulin, such as insulin glargine, to existing oral therapy can help 
      patients attain recommended glycaemic control targets, including haemoglobin 
      A(1c) (HbA(1c)) <7% and fasting blood glucose <5.5 mmol/l (<100 mg/dl). For 
      patients close to but not at target, the management of postprandial glucose 
      excursions with a rapid-acting insulin, such as insulin glulisine, can provide 
      further improvements in glycaemic control. In this review, the options for 
      intensifying insulin therapy with the addition of one or more daily doses of 
      prandial insulin are discussed. In addition, the advantages/disadvantages of 
      choosing a basal-bolus vs. a premixed insulin strategy are discussed. A 
      conceptually simple approach for the treatment of T2DM is for optimization of the 
      basal insulin dose (added to oral antidiabetic drugs) to target fasting glycaemia 
      followed by the addition of a single prandial dose of rapid-acting insulin to 
      target the largest glucose excursion. A second and third dose of prandial insulin 
      can then be added if HbA(1c) remains above target and to manage postprandial 
      glucose excursions at other meals. Prospective studies are underway to further 
      examine this concept and determine the benefit of this approach not only on 
      overall glycaemic control but also on cardiovascular risk.
FAU - Raccah, D
AU  - Raccah D
AD  - Department of Diabetology, University Hospital Sainte Marguerite, Marseille, 
      France. denis.raccah@mail.ap-hm.fr
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Diabetes Obes Metab
JT  - Diabetes, obesity & metabolism
JID - 100883645
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Insulin, Long-Acting)
RN  - 2ZM8CX04RZ (Insulin Glargine)
RN  - 7XIY785AZD (insulin glulisine)
SB  - IM
MH  - Administration, Oral
MH  - Blood Glucose/*metabolism
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy
MH  - Drug Therapy, Combination
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemic Agents/*administration & dosage
MH  - Insulin/*administration & dosage/*analogs & derivatives
MH  - Insulin Glargine
MH  - Insulin, Long-Acting
MH  - Postprandial Period
MH  - Randomized Controlled Trials as Topic
RF  - 32
EDAT- 2008/07/17 09:00
MHDA- 2009/04/03 09:00
CRDT- 2008/07/17 09:00
PHST- 2008/07/17 09:00 [pubmed]
PHST- 2009/04/03 09:00 [medline]
PHST- 2008/07/17 09:00 [entrez]
AID - DOM846 [pii]
AID - 10.1111/j.1463-1326.2008.00846.x [doi]
PST - ppublish
SO  - Diabetes Obes Metab. 2008 Jul;10 Suppl 2:76-82. doi: 
      10.1111/j.1463-1326.2008.00846.x.