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Options for prandial glucose management in type 2 diabetes patients using basal insulin: addition of a short‐acting GLP‐1 analogue versus progression to basal‐bolus therapy |
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| Authors: | I. B. Hirsch J. B. Buse J. Leahy J. B. McGill A. Peters H. W. Rodbard J. S. Skyler C. A. Verderese M. C. Riddle |
| Affiliation: | 1. Department of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, , Seattle, WA, USA;2. Division of Endocrinology, University of North Carolina School of Medicine, , Chapel Hill, NC, USA;3. Division of Endocrinology, Diabetes and Metabolism, University of Vermont, , Burlington, VT, USA;4. Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, , St. Louis, MO, USA;5. Division of Endocrinology, Keck School of Medicine, University of Southern California, , Los Angeles, CA, USA;6. Endocrine and Metabolic Consultants, , Rockville, MD, USA;7. Division of Endocrinology, Diabetes & Metabolism, University of Miami Miller School of Medicine, , Miami, FL, USA;8. The Diabetes Education Group, , Lakeville, CT, USA;9. Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, , Portland, OR, USA |
| Abstract: | Integrating patient‐centered diabetes care and algorithmic medicine poses particular challenges when optimized basal insulin fails to maintain glycaemic control in patients with type 2 diabetes. Multiple entwined physiological, psychosocial and systems barriers to insulin adherence are not easily studied and are not adequately considered in most treatment algorithms. Moreover, the limited number of alternatives to add‐on prandial insulin therapy has hindered shared decision‐making, a central feature of patient‐centered care. This article considers how the addition of a glucagon‐like peptide 1 (GLP‐1) analogue to basal insulin may provide new opportunities at this stage of treatment, especially for patients concerned about weight gain and risk of hypoglycaemia. A flexible framework for patient–clinician discussions is presented to encourage development of decision‐support tools applicable to both specialty and primary care practice. |
| Keywords: | GLP‐1 analogue insulin analogues insulin intensive management |