Physiologic Insulin Replacement in Type 2 Diabetes

Abstract

The purpose of this article is to review physiologic insulin replacement using a basal-prandial approach and focus on the role of postprandial glucose control. In addition, therapeutic options for optimizing glycemic control are described, including diabetes education, currently available agents, treatment regimens, and strategies. This article reviews the benefits of treating with a basal-prandial insulin approach and focuses on post-prandial glucose-targeted therapies, including rapid-acting insulin analogs. Data from landmark clinical trials in type 2 diabetes suggest that intensive glycemic control can reduce the frequency and severity of diabetes complications. A basal-prandial insulin regimen combines a long-acting insulin analog with a rapid-acting insulin to mimic normal physiologic insulin secretion, providing a flexible tool to enhance patient self-management. Strategies that include patient education, improved health care provider/patient communication, and basal-prandial insulin treatment can help patients achieve good glycemic control. The optimal setting for successful diabetes treatment is a team approach with the health care provider, nurse/certified diabetes educator, and patient as essential members.