The principles of basal insulin therapy in type 2 diabetes mellitus patients

Czech version

Authors: A. Adamíková
Authors‘ workplace: Diabetologické centrum IK KNTB, a. s., Zlín
Published in: Kardiol Rev Int Med 2014, 16(2): 144-147
Category: Internal Medicine

Overview

Chronic hyperglycaemia in patients with type 2 diabetes mellitus leads to the development of microvascular and macrovascular complications while significantly affecting morbidity and mortality. A whole line of major clinical studies have proven that normalization of glycaemia levels can prevent or slow down the progression of later complications associated with diabetes. Around 25% of patients treated with oral antidiabetic drugs require insulin therapy to compensate for the progress of b‑ cell failure and to ensure glycaemic control. According to the ADA/ EASD guidelines, it is possible, if the diabetes is not satisfactorily controlled with oral antidiabetic drugs, to introduce insulin therapy by adding basal insulin to the existing treatment. In studies, the long‑term acting insulin analogues (glargine, degludec, detemir) have established the evidence of significantly reduced risk of hypoglycaemia, especially at night. In order to influence postprandial hyperglycaemia during basal insulin therapy it is possible to use the combination with short‑term acting GLP‑1 receptor agonists. The therapy presents a reduced risk of hypoglycaemia than basal/ bolus insulin therapy as well as a lower risk of weight increase. It directly impacts the pathophysiology of type 2 diabetes mellitus.

Keywords:
type 2 diabetes mellitus – oral antidiabetic drugs – basal insulin analogue – hypoglycaemia – GLP‑1 receptor agonists

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