Basal insulin therapy in patients with type 2 diabetes mellitus: aspects of early initiation, advantages, constraints, and prospects

Abstract

Intensive control of glycemia starting from the onset of type 2 diabetes mellitus (DM2) is of primary importance for the long-term prognosis of the disease and the reduction of risk of cardiovascular complications. The strategy of early intensive therapy of DM2 thus far remains a matter of fierce dispute among diabetologists. The problem of choice of an optimal regime for the start of insulin therapy does not have an unambiguous solution either. Hypoglycemia is the main factor that traditionally hampers wide application of insulin therapy in patients with type 2 diabetes mellitus. The choice in favour of basal therapy with insulin analogs has the advantage of reaching the target parameters of carbohydrate metabolism at a significantly lower risk of hypoglycemia compared with other strategies of insulin therapy.