Intensification of Insulin Therapy for Type 2 Diabetic Patients in Primary Care: Basal-Bolus Regimen Versus Premix Insulin Analogs: When and for whom?

摘要

In April 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a joint position statement regarding treatment of hyperglyce-mia in type 2 diabetes, "Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach" (1). As most diabetic patients (>366 million worldwide) (2) are treated by their primary family physician and not by an endocrinol-ogist or diabetologist, the guidelines were intended to help physicians choose the best treatment for their patients. Some of the advantages of this position statement, over previous guidelines (3-8), are as follows: emphasizing the importance of indrvidualization of treatment, widening treatment options, and stating the pros and cons of the different treatment option. However, as the statement was written by a group of world-known diabetologists, without the input of nurses, dietitians, family physicians, or the patients themselves, questions have been raised as to how "patient-centered" it actually is and how useful and relevant it is to the primary care setting. Choosing the best insulin regimen for initiation and intensification of insulin therapy in type 2 diabetic patients is still debatable both in the specialist clinic and in the primary care setting. The intention of this article is to review the data available and offer reasonable guidance regarding the selection of the preferred insulin regimen for initiation and intensification of insulin treatment, especially in a primary care setting.