The need for early intensification of therapy in type 2 diabetes patients with suboptimal glycaemic control


Authors: Peter Novodvorský 1,2,3
Authors‘ workplace: metabolické centrum s. r. o., Trenčín 1;  Centrum diabetologie IKEM, Praha 2;  Department of Oncology and Metabolism, Medical School, University of Sheffield, United Kingdom 3
Published in: Forum Diab 2022; 11(2): 113-116
Category:

Overview

The progressive, not static nature of the course of type 2 diabetes mellitus (T2DM) predisposes this disease to regular monitoring and adjustment (intensification) of therapy. The goal is optimal glycaemic control at all times. In this article, I present the rationale for optimal glycaemic compensation and early intervention in the management of T2DM. I discuss the causal relationship of glycaemic compensation and risk of diabetic complications, the effect of metabolic memory, and clinical inertia, with a focus on decision making for further therapy intensification in the setting of poorly compensated T2DM on oral antidiabetic agents and basal insulin. Fixed-ratio combinations of basal insulins and GLP-1 receptor agonists positively affect 7 of the 8 pathological processes of the ominous octet, and thus represent the preferred choice in such situations. Recent clinical trials also provide evidence for their use as first-line insulin-based therapy.

Keywords:

type 2 diabetes – clinical inertia – IDegLira – insulin therapy – treatment intensification


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Labels
Diabetology Endocrinology Internal medicine
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