Algorithm for the introduction of rapid-acting insulin analogues in patients with type 2 diabetes on basal insulin therapy

• Published in: Practical diabetes international 2009-03, Vol.26 (2), p.70-77
• Main Authors: Owens, DR, Schalkwyk, C van, Smith, P, Beer, S, Goenka, N, Bain, SC, Bootle, S, Robertson, D, Robinson, A, Shaw, JAM
• Format: Article
• Language: English
• Subjects: basal insulin; dose titration algorithm; rapid-acting insulin analogue; type 2 diabetes
• ISSN: 1357-8170; 1528-252X
• DOI: 10.1002/pdi.1339

More than 4% of men and 3% of women in the UK are known to have type 2 diabetes. Furthermore, an ageing population and increasing prevalence of obesity, both associated with the onset of diabetes, mean that the number of people with the condition is expected to rise dramatically. Uncontrolled diabetes can lead to the development of complications such as retinopathy, neuropathy and myocardial infarction, the treatment of which places an ever increasing burden on health care services. The incidence of such complications can be reduced by adequate glycaemic control, and this can be achieved using an evolving therapeutic strategy which comprises a variety of treatment options involving oral hypoglycaemic agents and insulin preparations, tailored to meet the progressive nature of the condition. Diet and lifestyle modifications have limited long‐term success in maintaining glycaemic control, and it is recommended that metformin, an oral hypoglycaemic agent, is introduced from diagnosis. Meal‐related blood glucose peaks pose a particular challenge to achieving overall glycaemic control, and the introduction of prandial insulin using short‐acting insulin analogues is effective in quickly lowering postprandial blood glucose. This article presents an algorithm that has been developed to provide guidance to health care professionals on the use of prandial insulin to control excessive post‐meal glycaemic excursions in persons with type 2 diabetes inadequately controlled (HbA1c >7%) on basal insulin, with or without oral hypoglycaemic agents. Copyright ©2009 John Wiley & Sons.