Therapeutic Options for the Management of Postprandial Glucose in Patients With Type 2 Diabetes on Basal Insulin

Abstract

In Brief For patients with type 2 diabetes who require add-on therapy to metformin plus basal insulin, GLP-1 receptor agonists may be a favorable option because they effectively manage postprandial glucose, reduce body weight, and have an overall favorable safety profile compared to other agents. Given the wide range of treatment combinations available for type 2 diabetes management, health professionals must partner with patients to determine the best choices based on patients' individual lifestyle, resources, and treatment goals.

FIGURE 1.

ADA/EASD general recommendations for type 2 diabetes management (1). DPP-4-i, DPP-4 inhibitor; Fx’s, fractures; GLP-1-RA, GLP-1 receptor agonist; HF, heart failure; SU, sulfonylurea. ^aConsider beginning at this stage in patients with a very high A1C level (e.g., ≥9%). ^bConsider rapid-acting, nonsulfonylurea secretagogues (meglitinides) in patients with irregular meal schedules or who develop late postprandial hypoglycemia on sulfonylureas. ^cUsually a basal insulin (NPH, glargine, or detemir) in combination with noninsulin agents. ^dCertain noninsulin agents may be continued with insulin. Consider beginning at this stage if patient presents with severe hyperglycemia (≥300−350 mg/dL; A1C level ≥10.0−12.0%) with or without catabolic features (e.g., weight loss or ketosis).