PMID- 28792170 OWN - NLM STAT- MEDLINE DCOM- 20180918 LR - 20221207 IS - 0004-5772 (Print) IS - 0004-5772 (Linking) VI - 65 IP - 7 DP - 2017 Jul TI - Consensus on "Basal insulin in the management of Type 2 Diabetes: Which, When and How?". PG - 51-62 AB - INTRODUCTION: Type 2 diabetes mellitus (T2DM) has attained epidemic proportions and continues to increase despite the availability of a number of oral antidiabetic medications and major advances made in insulin delivery since its discovery nearly a hundred years ago. One, amongst many other reasons responsible for the inability to achieve adequate glycaemic control in a substantial proportion of T2DM patients is the delayed initiation and inappropriate intensification of insulin treatment. Appropriate initiation and intensification of insulin is critical for the successful achievement of tight glycaemic control. OBJECTIVE: To provide simple and easily implementable guidelines to primary care physicians on basal insulin initiation and intensification, along with use of basal insulin in special situations (hepatic failure, renal failure and gestational diabetes mellitus). METHODS: Each consensus statement on basal insulin initiation, intensification and use of basal insulin in special situations was evaluated for dosing and titration based on established guidelines, data from approved pack inserts, prescribing information or summary of product characteristics for each insulin type, and published scientific literature. These evaluations were then factored into the national context based not only on the clinical experience of the expert committee representatives' but also based on the common therapeutic practices followed in India to successfully achieve optimal glucose control. RESULTS: Recommendations on initiation and intensification of basal insulin, and its use in special situations, have been developed. The key recommendations are to initiate basal insulin when 2 or 3 oral antidiabetic medications fail to achieve target glycaemic control, or in symptomatic patients with glycated haemoglobin value greater than 9%. Depending upon patient characteristics, any of the four available basal insulins [Neutral protamine Hagedorn (NPH), Glargine (IGlar), Detemir (IDet), Degludec (IDeg)] can be used. However, IDeg has a longer duration of action, comparatively lesser hypoglycaemia (both overall and nocturnal) and more flexibility in administration timing compared to IGlar) and IDet. Inability to maintain glycaemic control should lead to prompt intensification of basal insulin treatment by adding mealtime insulin, consisting of one to three injections of either rapid-acting insulin analog or regular insulin; depending upon patient characteristics, intensification can also be achieved by transition from basal insulin to twice daily premixed insulin analogs/premixed human insulin/insulin co-formulations. IDeg/IDet can be used in all grades of renal and hepatic impairment; and IDet has been approved for use in gestational diabetes mellitus. CONCLUSIONS: We hope that these consensus based recommendations shall be a useful reference tool for health care practitioners and help them in initiating and intensifying insulin therapy in T2DM patients in order to achieve optimal glycaemic control. FAU - Ghosal, Samit AU - Ghosal S AD - Nightingale Hospital, Kolkata, West Bengal. FAU - Sinha, Binayak AU - Sinha B AD - Department of Endocrinology, AMRI Hospital, Kolkata, West Bengal. FAU - Majumder, Anirban AU - Majumder A AD - Department of Endocrinology, KPC Medical College, Kolkata, West Bengal. FAU - Das, Ashok Kumar AU - Das AK AD - Professor of Medicine and Professor and Head of Endocrinology, Pondicherry Institute of Medical Sciences, Dhanvantri Nagar, Gorimedu, Puducherry. FAU - Singh, Awadhesh Kumar AU - Singh AK AD - Consultant Endocrinologist, GD Hospital and Diabetes Institute, Kolkata, and Sun Valley Diabetes Research Center, Guwahati, Assam. FAU - Ghoshdastidar, Biswajit AU - Ghoshdastidar B AD - Woodlands Hospital, Kolkata, West Bengal. FAU - Maji, Debasish AU - Maji D AD - Department of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal. FAU - Goyal, Ghanshyam AU - Goyal G AD - ILS Hospitals and SK Diabetes Research Centre, Kolkata, West Bengal. FAU - Mukherjee, Jagat Jyoti AU - Mukherjee JJ AD - Department of Endocrinology and Diabetes, Apollo Gleneagles Hospital, Kolkata, West Bengal. FAU - Gangopadhyay, Kalyan Kumar AU - Gangopadhyay KK AD - Department of Endocrinology, Fortis and Peerless Hospital, Kolkata, West Bengal. FAU - John, Mathew AU - John M AD - Providence Endocrine and Diabetes Specialty Centre, Murinjapalam, Trivandrum, Kerala. FAU - Chatterjee, Sanjay AU - Chatterjee S AD - Apollo Gleneagles Hospitals, Kolkata, West Bengal. FAU - Jaggi, Shalini AU - Jaggi S AD - Consultant Diabetologist and Head at Dr. Mohans Diabetes Specialities Centre, New Delhi. FAU - Ray, Subir AU - Ray S AD - Consultant Endocrinologist, Apollo Gleneagles Hospital, Kolkata, West Bengal. FAU - Majumdar, Sujoy AU - Majumdar S AD - GD hospital and Diabetes Institute, Kolkata, West Bengal. FAU - Sharma, Surendra Kumar AU - Sharma SK AD - Diabetes, Thyroid and Endocrine Centre, Galaxy Speciality Centre, Jaipur, Rajasthan. LA - eng PT - Consensus Development Conference PT - Journal Article PL - India TA - J Assoc Physicians India JT - The Journal of the Association of Physicians of India JID - 7505585 RN - 0 (Blood Glucose) RN - 0 (Glycated Hemoglobin A) RN - 0 (Hypoglycemic Agents) RN - 0 (Insulin) SB - IM MH - Blood Glucose/analysis MH - Diabetes Mellitus, Type 2/*drug therapy MH - Dose-Response Relationship, Drug MH - Drug Administration Schedule MH - Glycated Hemoglobin/analysis MH - Humans MH - Hypoglycemic Agents/*administration & dosage MH - Insulin/*administration & dosage EDAT- 2017/08/10 06:00 MHDA- 2018/09/19 06:00 CRDT- 2017/08/10 06:00 PHST- 2017/08/10 06:00 [entrez] PHST- 2017/08/10 06:00 [pubmed] PHST- 2018/09/19 06:00 [medline] PST - ppublish SO - J Assoc Physicians India. 2017 Jul;65(7):51-62.