This activity will discuss how primary clinicians can address barriers to early initiation and appropriate intensification of insulin in patients with T2DM; recommend appropriate basal insulin regimens based on patients’ clinical needs, hypoglycemia risk, and drug clinical profile; and be aware of new and emerging basal insulins, which may have the potential of improving T2DM treatment and patient outcomes.
In this Expert Perspective, Dr. Guillermo E. Umpierrez provides his clinical insights into A1C targets, the importance of controlling both fasting and postprandial glucose in patients with type 2 diabetes, and the use of GLP-1 receptor agonists in combination with basal insulin for optimal glycemic control in patients who require intensification of therapy.
There are multiple advantages to early, intensive treatment of type 2 diabetes with targeted levels of A1C in the range of James R. Gavin III, MD, PhD, clinical professor of medicine at Emory University School of Medicine in Atlanta, Georgia and Dr. Jessica Castle, Assistant Professor at Oregon Health & Science University, respond to questions regarding the risks of weight gain and hypoglycemia associated with more intensive antihyperglycemic therapy and comment on strategies to ensure durable, successful treatment of diabetes.
In this case presentation, Kathleen Wyne, MD, PhD, Associate Professor of Clinical Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism at The Ohio State University College of Medicine shares strategies for intensification of diabetes management that incorporate real life patient challenges with evidence based medicine to develop a regimen that is likely to attain the patient’s A1C target. These strategies include working with what the patient is actually willing to do while trying to attain A1C target, with consideration to importance of controlling both fasting and postprandial glucose in patients with type 2 diabetes, and the use of GLP-1 receptor agonists in combination with basal insulin for optimal glycemic control in patients who require intensification of therapy.
Diabetes continues to have a significant impact on morbidity and mortality in the United States, and is an ongoing treatment challenge for primary care providers who lack confidence with treatment intensification including newer agents and combination therapies resulting in clinical inertia. Further, approaches to improved adherence and lifestyle modification through shared-decision making continue to evolve with the goal of improving quality of care.
The expanded number of therapies with varying mechanisms of action for type 2 diabetes has resulted in novel combination regimens for patients not achieving goals despite therapy with metformin. Dr. Serge Jabbour will review novel combinations and approaches to intensifying therapy in this interactive case study.
In this interactive case study, Dr. Richard Pratley, Medical Director of the Florida Diabetes Institute, walks through the clinical decision-making process for a 60-year-old African American woman with type 2 diabetes whose diabetes is progressing despite metformin therapy. Dr. Pratley examines factors likely contributing to this patient's poor glycemic control, as well as steps for intensification of therapy beyond metformin and considerations for treatment selection, such as risk for hypoglycemia and cardiovascular issues.