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. 2024 Oct;61(10):1267-1281.
doi: 10.1007/s00592-024-02285-2. Epub 2024 May 20.

Open questions on basal insulin therapy in T2D: a Delphi consensus

Delphi Board; Raffaella Buzzetti  1 , Riccardo Candido  2 , Katherine Esposito  3 , Andrea Giaccari  4 , Edoardo Mannucci  5 , Antonio Nicolucci  6 , Giuseppina T Russo  7
Collaborators, Affiliations

Open questions on basal insulin therapy in T2D: a Delphi consensus

Delphi Board et al. Acta Diabetol. 2024 Oct.

Abstract

Aims: The revolution in the therapeutic approach to type 2 diabetes (T2D) requires a rethinking of the positioning of basal insulin (BI) therapy. Given the considerable number of open questions, a group of experts was convened with the aim of providing, through a Delphi consensus method, practical guidance for doctors.

Methods: A group of 6 experts developed a series of 29 statements on: the role of metabolic control in light of the most recent guidelines; BI intensification strategies: (1) add-on versus switch; (2) inertia in starting and titrating; (3) free versus fixed ratio combination; basal-bolus intensification and de-intensification strategies; second generation analogues of BI (2BI). A panel of 31 diabetologists, by accessing a dedicated website, assigned each statement a relevance score on a 9-point scale. The RAND/UCLA Appropriateness Method was adopted to assess the existence of disagreement among participants.

Results: Panelists showed agreement for all 29 statements, of which 26 were considered relevant, one was considered not relevant and two were of uncertain relevance. Panelists agreed that the availability of new classes of drugs often allows the postponement of BI and the simplification of therapy. It remains essential to promptly initiate and titrate BI when required. BI should always, unless contraindicated, be started in addition to, and not as a replacement, for ongoing treatments with cardiorenal benefits. 2BIs should be preferred for their pharmacological profile, greater ease of self-titration and flexibility of administration.

Conclusion: In a continuously evolving scenario, BI therapy still represents an important option in the management of T2D patients.

Keywords: Basal insulin therapy; Expert consensus; Therapeutic inertia; Type 2 diabetes.

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Conflict of interest statement

R. Buzzetti received compensation or funding from the following Pharmaceutical and/or Diagnostic Companies: Sanofi, Novo Nordisk, Eli Lilly, Abbott, Astrazeneca, Vertex, Guidotti. R. Candido received consultancy fees from Boehringer Ingelheim, Eli-Lilly, Novo Nordisk, Astra-Zeneca, Sanofi-Aventis, Roche Diabetes Care; speaking fees from Astra Zeneca, Boehringer Ingelheim, Eli-Lilly, Novo Nordisk, Sanofi, Mundipharma Pharmaceutical, Abbott, MSD, Neopharmed Gentili, Menarini, Essex Italia, Ascensia Diabetes. K. Esposito received speaking and lecture fees from Novo Nordisk and Ely Lilly and has provided consultancy services to Roche. A. Giaccari received speaker’s fees and/or Advisory Board from Lilly, Novo-Nordisk, and Sanofi. E. Mannucci received consultancy and/or speaking fees from Eli Lilly, Novo Nordisk, and Sanofi. A. Nicolucci received funding for research from Sanofi, NovoNordisk, Alfasigma, Pikdare, AstraZeneca, Johnson & Johnson, Medtronic, Shionogi, SOBI, Meteda, and Theras. G. Russo is on the advisory board and received consultancy and lectures fees from Novo Nordisk, Astra Zeneca, Sanofi, Boehringer, Lilly, Mundipharma, and Sanchio.

Figures

Fig. 1
Fig. 1
Structure of the DELPHI Consensus
See this image and copyright information in PMC

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