• Users Online: 331
  • Print this page
  • Email this page
REVIEW ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 3  |  Page : 148-157

Indian reality of managing type 2 diabetes: an expert review of global and national guidelines for optimum insulin use


1 Diabetes Care and Research Centre, Patna, Bihar, India
2 Galaxy Speciality Centre, Jaipur, Rajasthan, India
3 Jaipur Diabetes Research Centre, Jaipur, Rajasthan, India
4 Rudraksh Super Speciality Care, Siliguri, West Bengal, India
5 Arthur Asirvatham Hospital, Madurai, Tamil Nadu, India
6 S L Raheja Hospital, Mumbai, Maharashtra, India
7 Pondicherry Institute of Medical Sciences, Pondicherry, India
8 Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Ajay Kumar
Consultant Physician and Diabetologist and Director, Diabetes Care & Research Centre, Patna, Bihar.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOD.JOD_59_20

Rights and Permissions

Several guidelines provide recommendations on insulin therapy in people with type 2 diabetes mellitus (T2DM). Major global guidelines have been adapted in multiple countries, and local consensus recommendations have been published giving guidance on insulin therapy considering local realities. This expert review focuses on the recommendations from global and Indian guidelines on insulin therapy in people with T2DM. It emphasizes on a patient-centric approach, including the glycemic parameters, psychosocial aspects, phase of life, and the Indian realities of T2DM management in guiding optimum insulin therapy for initiation and intensification. Therapeutic inertia towards timely insulin initiation needs to be bridged. Owing to the high carbohydrate diet and high postprandial glucose (PPG) excursions, insulin co-formulation and premix insulins offering total glycemic control can be preferred for a timely insulin initiation in Indians with T2DM that is uncontrolled despite multiple oral antidiabetic drugs. They also provide simplicity and convenience for insulin initiation and intensification. Among basal insulins, insulin degludec and glargine U300 are found to be safer, and offer more dosing flexibility than the first-generation basal insulin analogs. Faster-acting insulin aspart has been shown to provide better PPG control and dosing flexibility compared to a rapid-acting insulin analog with a lower risk of hypoglycemia. Thus, based on available evidences, a preferred use of insulin analog over conventional human insulins is suggested, keeping cost considerations in mind. The review also discusses optimum use of concomitant medications with insulin therapy for T2DM management.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed140    
    Printed5    
    Emailed1    
    PDF Downloaded49    
    Comments [Add]    

Recommend this journal