Initiation of Basal Insulin in Patients with Uncontrolled Type 2 Diabetes Mellitus

Muneer Salih Muneer

doi:10.4236/ojemd.2020.106009

Abstract

Type 2 diabetes mellitus is a growing health problem, characterized by insulin resistance progressing to beta cell dysfunction and insulin deficiency, most of these patients will need intensification of treatment and initiation of insulin to delay or prevent diabetic complications. Glycemic control is the most important aspect of management, and in reducing morbidity and mortality of the diseases. Control of plasma glucose in patients with diabetes can be assessed by HbA1c, FPG, PPG, but still HbA1c% remains the gold standard for assessment of glycemic control and follow up of diabetic patients. The aim of this study is to assess HbA1c% in patients on oral anti-diabetic drugs, with poor glycemic control before and after adding basal insulin, with titration of the dose of insulin depending on fasting blood sugar. 82 patients with uncontrolled type 2 diabetes (43.9% male, 56.1% female), with HbA1c more than 9%, on two types of oral diabetic medication or more, were started on basal insulin (glargine, lantus) and followed for three to six months. Overall 82 patients with type 2 diabetes mellitus were included in the study. The mean age of the study population was 58.4 years, the mean duration of the disease range was 13.4 years. All patients with HbA1c more than 9%, without organ failure, were included in the study. The mean HbA1c overall had decreased from mean of 11.15% before starting basal insulin to the mean of 8.43% within 3 to 6 month, after initiating basal insulin, this difference was significant at p ive type 2 diabetic patients resulted in significant improvement of glycemic control, with improved HbA1c level, without adverse effects.

Highlights

Type 2 diabetes mellitus (T2DM) is a growing health problem, leading to morbidity and mortality
The aim of this study is to assess HbA1c% in patients on oral anti-diabetic drugs, with poor glycemic control before and after adding basal insulin, with titration of the dose of insulin depending on fasting blood sugar. 82 patients with uncontrolled type 2 diabetes (43.9% male, 56.1% female), with HbA1c more than 9%, on two types of oral diabetic medication or more, were started on basal insulin and followed for three to six months
The addition of basal insulin to oral anti-diabetic medication in uncontrolled insulin-naïve type 2 diabetic patients resulted in significant improvement of glycemic control, with improved HbA1c level, without adverse effects

Summary

Introduction

Type 2 diabetes mellitus (T2DM) is a growing health problem, leading to morbidity and mortality. T2DM is characterized by insulin resistance progressing to beta cell-dysfunction and insulin deficiency. T2DM accounts for 90% of all cases of diabetes, the vast majority of patients who are on oral hypoglycemic agents are uncontrolled, with above needed target of HbA1c level, and the glycemic control tends to worsen over time, these patients need insulin, as their ability to produce their own insulin from pancreatic beta cells declines progressively [1]. The UK Prospective Diabetes Study (UKPDS) highlighted the progressive nature of T2DM and the need for intensification of treatment, and initiation of insulin to maintain satisfactory glycemic control [2]. Glycemic control in diabetes mellitus is needed to reduce morbidity and mortality of the disease. Glycated hemoglobin (HbA1c) is the gold standard for assessment of glycemic control [3]

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Methods

Conclusion