Addition of Basal Insulin to Oral Antidiabetic Agents: A Goal-Directed Approach to Type 2 Diabetes Therapy

Louis Kuritzky, MD


November 15, 2006


Combining basal insulin with oral therapy may help patients achieve the goals for glycemic control recommended by the ADA and the AACE. Each oral therapeutic class can provide specific benefits according to its respective intrinsic pharmacologic properties. Ideally, combination therapy should be individualized to match patient lifestyle, baseline A1C, comorbidities, insulin requirements, economics, personal preference, and patient convenience. Utilizing oral therapies with complementary mechanisms of action, eg, combining secretagogues with sensitizers, can maximize efficacy and minimize adverse events. Treatment with insulin provides replacement therapy that complements the insulin-sensitizing action of biguanides and thiazolidinediones. Secretagogues can work with exogenous insulin by raising endogenous insulin levels. Alpha-glucosidase inhibitors generally have a somewhat more modest add-on efficacy than other classes of oral agents but may be useful in patients who are very close to goal A1C (< 7.0%) and could benefit from an incremental reduction in postprandial glucose. The multiplicity of oral drugs available for use with insulin need not be viewed as confounding, but rather as an opportunity to individualize and intensify care for patients with type 2 diabetes.


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