In many patients with inadequately controlled type 2 diabetes, insulin is added to the treatment regimen. This often includes a daily dose of a long-acting insulin, as well as rapid-acting or short-acting insulin, sometimes with a sliding scale, to control elevated glucose following meals. Thus, treatment with insulin can impose a major burden, requiring patients to check blood glucose and inject insulin multiple times per day and to appropriately adjust insulin doses. The use of rapid-acting or short-acting insulin can also increase the risk for hypoglycemia, which is of particular concern in the elderly. In a research letter published in this issue of JAMA Internal Medicine,1 Munshi et al provide preliminary data to suggest that, compared with multiple doses of insulin, a single dose of basal insulin results in less hypoglycemia with little effect on glycated hemoglobin.
The study by Munshi et al1 is small and did not include a concurrent control group, so the evidence should be considered preliminary. However, we decided to publish the study because we believe it should inspire larger trials to investigate optimum insulin regimens that minimize hypoglycemia and patient burden. While the participants in the study by Munshi et al were elderly, we see no reason why such a simplified regimen should not also be considered in younger patients with type 2 diabetes.
Conflict of Interest Disclosures: None reported.
Grady D. Simplification of Insulin Regimens in Patients With Type 2 Diabetes. JAMA Intern Med. 2016;176(7):1025. doi:10.1001/jamainternmed.2016.2298