Abstract
Evidence suggests a major contribution of postprandial glucose (PPG) excursions to the increased risk of micro- and macro-vascular complications in individuals with type 2 diabetes mellitus (T2DM). Administration of bolus insulin remains a very effective therapeutic option for PPG control. The aim of this expert group recommendation document was to provide practical and easy-to-execute guidelines for physicians on the appropriate use of bolus insulin in the management of T2DM. A panel of key opinion leaders from India reviewed and discussed the available clinical evidence and guideline recommendations on the following topics: (1) optimum control of PPG; (2) choice of bolus insulin; and (3) special situations and practical considerations. The expert panel critically analyzed the current literature and clinical practice guidelines and factored their rich clinical experience to develop a set of nine expert group recommendations for the effective use of bolus insulin. These recommendations will not only result in a more evidence-based application of bolus insulin in the clinical setting but also trigger further research and provide a valuable base for the development of future guidelines on the use of bolus insulin in the management of individuals with T2DM.
Highlights
In the year 2017, India and China recorded the highest number of individuals with diabetes within the age group of 20–79 years (72.9 million and 114.4 million, respectively) [1]
Sci. 2021, 9, 38 guidelines related to management of type 2 diabetes mellitus (T2DM) (n = 24) on postprandial glucose, and the use of bolus insulin
A study conducted among 290 individuals with T2DM in Europe revealed that the contribution of PPG excursions is predominant when T2DM is fairly controlled, i.e., when the HbA1c quartiles are low, whereas the contribution of FPG is progressively increased with worsening diabetes control, i.e., when the HbA1c quartiles are high [13]
Summary
In the year 2017, India and China recorded the highest number of individuals with diabetes within the age group of 20–79 years (72.9 million and 114.4 million, respectively) [1]. When compared to the Western population, they have a younger age of onset; relatively high body-fat percentage, waist-to-hip ratio, and insulin resistance; a rapid decrease in β-cell function; and a high predisposition to cardiovascular disease (CVD) [3,4,5,6] Risk factors such as sedentary lifestyle, consumption of high-sugar diets, and increased total dietary carbohydrate intake contribute to an increased risk of T2DM in Indians [7,8]. Since 2009, several expert group recommendations and evidence-based guidelines on the various aspects of use of insulin in individuals with diabetes mellitus have been published in India. These recommendations guide the treating clinicians on the choice, dose, and intensification of insulin. We set out to develop a consensus document on the choice, dosing, and titration of bolus insulin in the management of T2DM
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