PMID- 31102253 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231012 IS - 1869-6953 (Print) IS - 1869-6961 (Electronic) IS - 1869-6961 (Linking) VI - 10 IP - 4 DP - 2019 Aug TI - BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion. PG - 1189-1204 LID - 10.1007/s13300-019-0629-z [doi] AB - The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring.Funding: Sanofi. FAU - Bajaj, Sarita AU - Bajaj S AD - Department of Medicine, MLN Medical College, Allahabad, India. FAU - Das, A K AU - Das AK AD - Department of Medicine, JIPMER, Puducherry, India. FAU - Kalra, Sanjay AU - Kalra S AD - Department of Diabetes and Endocrinology, Bharti Hospital, Karnal, India. brideknl@gmail.com. FAU - Sahay, Rakesh AU - Sahay R AD - Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad, India. FAU - Saboo, Banshi AU - Saboo B AD - Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, India. FAU - Das, Sambit AU - Das S AD - Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India. FAU - Shunmugavelu, M AU - Shunmugavelu M AD - Trichy Diabetes Speciality Centre (P) Ltd., Trichy, India. FAU - Jacob, Jubbin AU - Jacob J AD - Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College and Hospital, Ludhiana, India. FAU - Priya, Gagan AU - Priya G AD - Fortis Hospital, Mohali, India. FAU - Khandelwal, Deepak AU - Khandelwal D AD - Department of Endocrinology, Maharaja Agrasen Hospital, Delhi, India. FAU - Dutta, Deep AU - Dutta D AD - Department of Endocrinology, Diabetology and Metabolic Disorders, Venkateshwar Hospital, New Delhi, India. FAU - Chawla, Manoj AU - Chawla M AD - Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India. FAU - Surana, Vineet AU - Surana V AD - Manipal Hospitals, New Delhi, India. FAU - Tiwaskar, Mangesh AU - Tiwaskar M AD - Shilpa Medical Research Centre, Mumbai, India. FAU - Joshi, Ameya AU - Joshi A AD - Bhaktivedanta Hospital and Research Institute, Thane, India. FAU - Shrestha, Pradip Krishna AU - Shrestha PK AD - Nidan Hospital Pvt. Ltd., Patan, Nepal. FAU - Bhattarai, Jyoti AU - Bhattarai J AD - Metro Kathmandu Hospital, Kathmandu, Nepal. FAU - Bhowmik, Bishwajit AU - Bhowmik B AD - Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh. FAU - Latt, Tint Swe AU - Latt TS AD - University of Medicine 2, Yangon, Myanmar. FAU - Aye, Than Than AU - Aye TT AD - University of Medicine 2, Myanmar Society of Endocrinology and Metabolism (MSEM), Yangon, Myanmar. FAU - Vijayakumar, G AU - Vijayakumar G AD - Apollo Specialty Hospital and Diabetes Medicare Centre, Chennai, India. FAU - Baruah, Manash AU - Baruah M AD - Excel Care Hospitals, Guwahati, India. FAU - Jawad, Fatema AU - Jawad F AD - Journal of Pakistan Medical Association, Karachi, Pakistan. FAU - Unnikrishnan, A G AU - Unnikrishnan AG AD - Chellaram Diabetes Hospital, Pune, India. FAU - Chowdhury, Subhankar AU - Chowdhury S AD - Department of Endocrinology, IPGME&R and SSKM Hospital, Kolkata, India. FAU - Pathan, Md Faruqe AU - Pathan MF AD - Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh. FAU - Somasundaram, Noel AU - Somasundaram N AD - Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka. FAU - Sumanathilaka, Manilka AU - Sumanathilaka M AD - National Hospital of Sri Lanka, Sri Lanka College of Endocrinologists, Colombo, Sri Lanka. FAU - Raza, Abbas AU - Raza A AD - Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. FAU - Bahendeka, Silver K AU - Bahendeka SK AD - Mother Kevin Postgraduate Medical School, Martyrs University, St. Francis Hospital, Kampala, Uganda. FAU - Coetzee, Ankia AU - Coetzee A AD - Division of Endocrinology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Society for Endocrinology, Diabetes and Metabolism, Cape Town, South Africa. FAU - Ruder, Sundeep AU - Ruder S AD - Life Fourways Hospital, University of the Witwatersrand, Cape Town, South Africa. FAU - Ramaiya, Kaushik AU - Ramaiya K AD - Shree Hindu Mandal Hospital, Dar e Salaam, Tanzania. FAU - Lamptey, Roberta AU - Lamptey R AD - Korle Bu Teaching Hospital, University of Ghana School of Medicine and Dentistry, Accra, Ghana. FAU - Bavuma, Charlotte AU - Bavuma C AD - College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda. FAU - Shaikh, Khalid AU - Shaikh K AD - Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman. FAU - Uloko, Andrew AU - Uloko A AD - College of Health Sciences, Bayero University, Kano, Nigeria. FAU - Chaudhary, Sandeep AU - Chaudhary S AD - NMC Speciality Hospital, Dubai, UAE. FAU - Abdela, Abdurezak Ahmed AU - Abdela AA AD - Department of Internal Medicine, School of Medicine, CHS, Addis Ababa University, Addis Ababa, Ethiopia. FAU - Akanov, Zhanay AU - Akanov Z AD - Kazakh Society for Study of Diabetes, Almaty, Kazakhstan. FAU - Rodriguez-Saldana, Joel AU - Rodriguez-Saldana J AD - Multidisciplinary Diabetes Center of Mexico, Mexico City, Mexico. FAU - Faradji, Raquel AU - Faradji R AD - Clinica EnDi, RENACED Diabetes Tipo 1, Escuela de Medicina, TEC-ABC, Centro Medico ABC, Sociedad Mexicana de Nutricion y Endocrinologia, Mexico City, Mexico. FAU - Tiago, Armindo AU - Tiago A AD - Mozambican Diabetic Association, Maputo Central Hospital, Maputo, Mozambique. FAU - Reja, Ahmed AU - Reja A AD - Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia. FAU - Czupryniak, Leszek AU - Czupryniak L AD - Department of Diabetology and Internal Medicine, Central University Hospital, Warsaw Medical University, Warsaw, Poland. LA - eng PT - Journal Article PT - Review DEP - 20190517 PL - United States TA - Diabetes Ther JT - Diabetes therapy : research, treatment and education of diabetes and related disorders JID - 101539025 PMC - PMC6612329 OTO - NOTNLM OT - Basal insulin OT - Degludec OT - Detemir OT - Glargine OT - Hypoglycemia OT - Titration OT - Type 2 diabetes mellitus EDAT- 2019/05/19 06:00 MHDA- 2019/05/19 06:01 PMCR- 2019/05/17 CRDT- 2019/05/19 06:00 PHST- 2019/03/19 00:00 [received] PHST- 2019/05/19 06:00 [pubmed] PHST- 2019/05/19 06:01 [medline] PHST- 2019/05/19 06:00 [entrez] PHST- 2019/05/17 00:00 [pmc-release] AID - 10.1007/s13300-019-0629-z [pii] AID - 629 [pii] AID - 10.1007/s13300-019-0629-z [doi] PST - ppublish SO - Diabetes Ther. 2019 Aug;10(4):1189-1204. doi: 10.1007/s13300-019-0629-z. Epub 2019 May 17.