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Introduction to Basal Insulin Therapy: Clinical Management of Diabetes
Jasmine D. Gonzalvo, PharmD, BCPS, BC-ADM, CDE, LDE
Evaluating New-Generation Basal Insulin Therapy Participating Faculty

Introduction to Basal Insulin Therapy: Clinical Management of Diabetes

Jasmine D. Gonzalvo, PharmD, BCPS, BC-ADM, CDE, LDE
Combination products of basal insulins with GLP-1 receptor agonists are also newly approved, including insulin degludec/liraglutide and insulin glargine/lixisenatide. These medications are administered once daily. Both combination products have demonstrated weight loss in patients as compared with weight gain with insulin treatment alone. Trials have also demonstrated lower rates of hypoglycemia as compared with insulin monotherapy.40,41


Diabetes is a complex and serious illness that affects the lives of millions of people in the United States and worldwide.5 Many dangerous complications often arise due to years of significant hyperglycemia that eventually causes harm to different organ systems in the body.15 Diabetes is associated with high rates of morbidity and mortality, and it  is reported to be the seventh leading cause of death in the United States.4 The prevalence of diabetes is on the rise and is considered a serious health crisis that impacts a person’s overall health status and quality of life, and is a burden to the US healthcare system.8 Stringent glycemic management is the cornerstone for preventing the myriad of complications that can arise from diabetes and is strongly recommended by both the ADA and AACE.2,3 Although most people with T2D will start oral antidiabetic agents initially, eventually many will require insulin therapy.3 Innovative, longer-acting insulin products that closely resemble endogenous insulin secretion patterns are improving glycemic management in patients with diabetes.37,42

Author affiliation: Clinical associate professor, College of Pharmacy, Purdue University, West Lafayette, IN.
Funding source: This activity is supported by an educational grant from Sanofi US.
Author disclosure: Dr. Gonzalvo reports receipt of payment for serving as a consultant/being on advisory boards for Lilly, Merck, and Novo Nordisk.
Authorship information: Drafting of the manuscript, critical revision of the manuscript for important intellectual context, and supervision.
Address correspondence to:
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  9. Preventing type 2 in children. American Diabetes Assocation. Updated December 30, 2014. Accessed February 15, 2018.
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  12. Kim S. Burden of hospitalizations primarily due to uncontrolled diabetes. Diabetes Care. 2007;30(5):1281-1282. doi: 10.2337/dc06-2070.
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  14. ORIGIN Trial Investigators. Cardiovascular and other outcomes postintervention with insulin glargine and omega-3 fatty acids (ORIGINALE). Diabetes Care. 2016;39(5):709-716. doi: 10.2337/dc15-1676.
  15. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS38 [published correction in BMJ. 1999;318(7175):29]. BMJ. 1998;317(7160):703-713.
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  22. Escalada J, Orozco-Beltran D, Morillas C, et al. Attitudes towards insulin initiation in type 2 diabetes patients among healthcare providers: a survey research. Diabetes Res Clin Pract. 2016;122:46-53. doi:  10.1016/j.diabres.2016.10.003.
  23. Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384-1395. doi:  10.2337/dc12-2480.
  24. The DCCT Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med. 1991;90(4):450-459.
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  26. Abrahamson MJ, Peters A. Intensification of insulin therapy in patients with type 2 diabetes mellitus: an algorithm for basal-bolus therapy. Ann Med. 2012;44(8):836-846. doi: 10.3109/07853890.2012.699715.
  27. Meneghini LF, Orozco-Beltran D, Khunti K, et al. Weight beneficial treatments for type 2 diabetes. J Clin Endocrinol Metab. 2011;96(11):3337-3353. doi: 10.1210/jc.2011-1074.
  28. Holman RR, Thorne KI, Farmer AJ, et al; 4-T Study Group. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med. 2007;357(17):1716-1730. doi: 10.1056/NEJMoa075392.
  29. Zafar A, Stone MA, Davies MJ, Khunti K. Acknowledging and allocating responsibility for clinical inertia in the management of type 2 diabetes in primary care: a qualitative study. Diabet Med. 2015;32(3):407-413. doi: 10.1111/dme.12592.
  30. Zafar A, Davies M, Azhar A, Khunti K. Clinical inertia in management of T2DM. Prim Care Diabetes. 2010;4(4):203-207. doi: 10.1016/j.pcd.2010.07.003.
  31. Strain WD, Blüher M, Paldánius P. Clinical inertia in individualising care for diabetes: is there time to do more in type 2 diabetes? Diabetes Ther. 2014;5(2):347-354. doi: 10.1007/s13300-014-0077-8.
  32. Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med. 2001;135(9):825-834.
  33. Vora J, Cariou B, Evans M, et al. Clinical use of insulin degludec. Diabetes Res Clin Pract. 2015;109(1):19-31. doi: 10.1016/j.diabres.2015.04.002.
  34. Biosimilar and interchangeable products. Food and Drug Administration website. Accessed February 16, 2018.
  35. Basaglar [prescribing information]. Indianapolis, IN: Lilly USA, LLC, and Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc; 2016. Accessed February 23, 2018.
  36. Rosenstock J, Hollander P, Bhargava A, et al. Similar efficacy and safety of LY2963016 insulin glargine and insulin glargine (Lantus) in patients with type 2 diabetes who were insulin-naïve or previously treated with insulin glargine: a randomized, double-blind controlled trial (the ELEMENT 2 study). Diabetes Obes Metab. 2015;17(8):734-741. doi: 10.1111/dom.12482.
  37. Bolli GB, Riddle MC, Bergenstal RM, et al; the EDITION 3 study investigators. New insulin glargine 300 U/ml compared with glargine 100 U/ml in insulin-naïve people with type 2 diabetes on oral glucose-lowering drugs: a randomized controlled trial (EDITION 3). Diabetes Obes Metab. 2015;17(4):386-394. doi: 10.1111/dom.12438.
  38. Riddle MC, Bolli GB, Zieman M, Muehlen-Bartmer I, Bizet F, Home PD; EDITION 1 Study Investigators.. New insulin glargine 300 units/mL versus glargine 100 units/mL in people with type 2 diabetes using basal and mealtime insulin: glucose control and hypoglycemia in a 6-month randomized controlled trial (EDITION 1). Diabetes Care. 2014;37(10):2755-2762. doi:  10.2337/dc14-0991.
  39. Yki-Järvinen H, Bergenstal RM, Ziemen M, et al; EDITION 2 Study Investigators. New insulin glargine 300 U/mL versus glargine 100 U/mL in people with type 2 diabetes using oral agents and basal insulin: glucose control and hypoglycemia in a 6-month randomized controlled trial (EDITION 2). Diabetes Care. 2014;37(12):3235-3243. doi: 10.2337/dc14-0990.
  40. Soliqua efficacy and safety. Sanofi website. Accessed February 16, 2018.
  41. Xultophy efficacy and safety. Novo Nordisk website. Accessed February 16, 2018.
  42. Sanofi [data on file]. TAKE CONTROL study, EUdraCT number 2015-001626-42, September 2017. Accessed January 18, 2018.
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