Worldwide, both underdiagnosis and undertreatment leave many patients exposed to long periods of
hyperglycemia and contribute to irreversible diabetes complications. Early glucose control reduces the risk of
both macrovascular and microvascular complications, while tight control late in diabetes has little or no
macrovascular benefit. Insulin therapy offers the most potent antihyperglycemic effect of all diabetes agents,
and has a unique ability to induce diabetes remission when used to normalize glycemia in newly diagnosed
patients. When used as a second-line therapy, basal insulin is more likely to safely and durably maintain A1C
levels ≤7% than when insulin treatment is delayed. The use of basal insulin analogs is associated with a
reduced risk of hypoglycemia and weight gain compared to NPH insulin and pre-mixed insulin. Patient selftitration
algorithms can improve glucose control while decreasing the burden on office staff. Finally, recent
data suggest that addition of incretin agents to basal insulin may improve glycemic control with very little, if
any increased risk of hypoglycemia or weight gain.
Worldwide, both underdiagnosis and undertreatment leave many patients exposed to long periods of
hyperglycemia and contribute to irreversible diabetes complications. Early glucose control reduces the risk of
both macrovascular and microvascular complications, while tight control late in diabetes has little or no
macrovascular benefit. Insulin therapy offers the most potent antihyperglycemic effect of all diabetes agents,
and has a unique ability to induce diabetes remission when used to normalize glycemia in newly diagnosed
patients. When used as a second-line therapy, basal insulin is more likely to safely and durably maintain A1C
levels ≤7% than when insulin treatment is delayed. The use of basal insulin analogs is associated with a
reduced risk of hypoglycemia and weight gain compared to NPH insulin and pre-mixed insulin. Patient selftitration
algorithms can improve glucose control while decreasing the burden on office staff. Finally, recent
data suggest that addition of incretin agents to basal insulin may improve glycemic control with very little, if
any increased risk of hypoglycemia or weight gain.
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