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Titrate Lantus

Selected Important Safety Information

Selected Important Safety Information

Selected Important Safety Information WARNING: RISK OF THYROID C-CELL TUMORS Liraglutide, one of the components of Xultophy® 100/3.6, causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Xultophy® 100/3.6 causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined. Xultophy® 100/3.6 is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of Xultophy® 100/3.6 and inform them of symptoms of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Xultophy® 100/3.6. Indications and Limitations of Use Xultophy® 100/3.6 (insulin degludec and liraglutide injection) 100 units/mL and 3.6 mg/mL is a combination of insulin degludec and liraglutide and is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus inadequately controlled on basal insulin (less than 50 units daily) or liraglutide (less than or equal to 1.8 mg daily). Xultophy® 100/3.6 is not recommended as first-line therapy for patients who have inadequate glycemic control on diet and exercise. Xultophy® 100/3.6 has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Xultophy® 100/3.6 is not recommended for us Continue reading >>

Lantus, Toujeo (insulin Glargine) Dosing, Indications, Interactions, Adverse Effects, And More

Lantus, Toujeo (insulin Glargine) Dosing, Indications, Interactions, Adverse Effects, And More

100 units/mL (Lantus SoloSTAR; Basaglar KwikPen; 3 mL disposable prefilled pens) 300 units/mL (Toujeo; 1.5 mL SoloStar disposable prefilled pen) 300 units/mL (Toujeo Max; 3 mL SoloStar disposable prefilled pen) Note: Recent studies have suggested that glargine-300 extends blood glucose control well beyond 24 hr Long-acting basal insulin indicated to improve glycemic control in adults with type 1 diabetes mellitus Start ~1/3 of total daily insulin dose; use remaining 2/3 of daily insulin dose on short-acting, premeal insulin Usual initial dose range: 0.2-0.4 units/kg; optimal glucose lowering effect may take 5 days to fully manifest and the first insulin glargine dose may be insufficient to cover metabolic needs in the first 24 hr of use Titrate insulin glargine per instructions, and adjust coadministered glucose-lowering therapies per standard of care See Dosing Considerations and Administration Long-acting basal insulin indicated to improve glycemic control in adults with type 2 diabetes mellitus Start 0.2 units/kg qDay; if necessary, adjust dosage of other antidiabetic drugs when starting insulin glargine to minimize the risk of hypoglycemia See Dosing Considerations and Administration Dose must be individualized based on clinical response; blood glucose monitoring is essential in all patients receiving insulin therapy Patients adjusting the amount or timing of dosage should do so only under medical supervision with appropriate glucose monitoring Titrate Toujeo dose no more frequently than every 3-4 days Use with caution in patients with visual impairment who may rely on audible clicks to dial their dose If changing from a treatment regimen with an intermediate- or long-acting insulin to a regimen with insulin glargine, the amount and timing of shorter-acting insulin Continue reading >>

Selected Important Safety Information

Selected Important Safety Information

Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant oral anti-diabetic treatment may be needed Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening Tresiba® (insulin degludec injection) is indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus. Tresiba® is not recommended for treating diabetic ketoacidosis or for pediatric patients requiring less than 5 units of Tresiba®. Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant oral anti-diabetic treatment may be needed Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening. Increase monitoring with changes to: insulin dose, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with hypoglycemia unawareness or renal or hepatic impairment Accidental mix-ups betwe Continue reading >>

Benefits Of Timely Basal Insulin Control In Patients With Type 2 Diabetes

Benefits Of Timely Basal Insulin Control In Patients With Type 2 Diabetes

1. Growing burden of diabetes Preventing diabetic complications in the growing population of people with diabetes depends first on improving the rate of diagnosis. Most diabetes agencies in the world recommend similar diagnostic criteria based on the fasting plasma glucose (FPG; ≤ 126 mg/dL) and 2-hour oral glucose tolerance test (OGTT; ≤ 200 mg/dL), but so far only the American Diabetes Association (ADA) recommends using the A1C test for diagnosis (Association AD, 2013; Force IDFcGT, 2012). Despite some challenges and controversies (lack of availability and/or standardization of the A1C assay in some areas and reliability of A1C results in patients with hemoglobinopathies and other conditions), the A1C test can be a convenient and useful tool for screening because patients' glucose levels can be tested in a nonfasting state (Association AD, 2013). Regardless of the diagnostic method used (and clinicians should make this choice according to their own preferences), at-risk populations should be screened on a regular basis, because prompt diagnosis and initiation of treatment are essential for preventing diabetic complications. 1.1. Undertreatment Unfortunately, among the diagnosed, undertreatment prevails throughout the world, where as many as one-half to two-thirds of patients do not have an A1C < 7% (Ali et al., 2013). According to data from the 2010 National Health and Nutrition Examination Survey (NHANES), only 52% of patients in the U.S. have A1C levels < 7%, while 13% have A1C levels > 9% (Ali et al., 2013). A 2009 study by the International Diabetes Management Practice Study (IDMPS) found that in Eastern Europe, Latin America, and Asia, only 36% of patients with type 2 diabetes (and even fewer with type 1) had ever had their A1C measured. Of those, only 36% ha Continue reading >>

How To Initiate, Titrate, And Intensify Insulin Treatment In Type 2 Diabetes

How To Initiate, Titrate, And Intensify Insulin Treatment In Type 2 Diabetes

US Pharm. 2007;32(10)(Diabetes suppl):10-16. Diabetes is a major public health problem that affects 7% of the United States population, or 20.8 million people.1 Type 2 diabetes accounts for 90% to 95% of the diabetes population and is diagnosed with increasing frequency, especially in adolescents and children. Nearly one third of individuals with diabetes are unaware of their illness, which delays the time to treatment and increases the risk of complications. Also, the cost of diabetes is staggering, with over $100 billion per year spent on the treatment of people with this disease. Diabetes is the leading cause of adult blindness, nontraumatic amputations, and end-stage renal disease. In addition, the death rates associated with heart disease and the risk of stroke are about two- to fourfold higher in adults with diabetes. These macrovascular complications account for 65% of deaths in people with the disease.1 Studies have documented that maintaining glycemic levels as close to normal as possible helps to reduce diabetes-specific complication risks.2-4 Each percentage point reduction in hemoglobin A1C (HbA1c)--equal to a drop in average plasma glucose of about 40 mg/dL--reduces the risk of microvascular disease by 37%.4 These observations have led to intensification of glycemic targets. The American Diabetes Association currently recommends that each patient maintains glycemic levels as close to normal as possible (HbA1c <6%) and minimally below 7%.5 Pathophysiology Normal physiological insulin secretion consists of a continuous basal secretion to control fasting and between-meal glucose and postprandial spikes in insulin to control meal-related hyperglycemia. Type 2 diabetes is characterized by insulin resistance and dysfunction in pancreatic beta- and alpha-cell func Continue reading >>

(insulin Glargine Injection) 300 Units/ml

(insulin Glargine Injection) 300 Units/ml

Toujeo® is a long-acting human insulin analog indicated to improve glycemic control in adults with diabetes mellitus. Limitations of Use: Toujeo® is not recommended for treating diabetic ketoacidosis. Contraindications Toujeo® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or any of its excipients. Warnings and Precautions Toujeo® contains the same active ingredient, insulin glargine, as Lantus®. The concentration of insulin glargine in Toujeo® is 300 Units per mL. Insulin pens and needles must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimens cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Changes in insulin regimen may result in hyperglycemia or hypoglycemia. Unit for unit, patients started on, or changed to, Toujeo® required a higher dose than patients controlled with Lantus®. When changing from another basal insulin to Toujeo®, patients experienced higher average fasting plasma glucose levels in the first few weeks of therapy until titrated to their individualized fasting plasma glucose targets. Higher doses were required in titrate-to-target studies to achieve glucose control similar to Lantus®. Hypoglycemia is the most common adverse reaction of insulin therapy, including Toujeo®, and may be life-threatening. Medication errors such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label bef Continue reading >>

Important Safety Information For Toujeoâ® Contraindications

Important Safety Information For Toujeoâ® Contraindications

Indications and Usage for Toujeo® Toujeo® is a long-acting human insulin analog indicated to improve glycemic control in adults with diabetes mellitus. Limitations of Use: Toujeo® is not recommended for treating diabetic ketoacidosis. Toujeo® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or any of its excipients. Please see additional Important Safety Information for Toujeo on next page. Please see full prescribing information from the Toujeo.com website from where you printed this information. a Units of Toujeo® are rounded down to the nearest whole unit. bThe appropriate starting dose in insulin-naive adult T1DM patients is kg x (0.2 – 0.4) = Units. Weight in lb (pounds) Starting insulin dose in Units Weight in lb (pounds) Starting insulin dose in Units 154-164 14 242-252 22 165-175 15 253-263 23 176-186 16 264-274 24 187-197 17 275-285 25 198-208 18 286-296 26 209-219 19 297-307 27 220-230 20 308-318 28 231-241 21 319-329 29 The starting dose of Toujeo® is based on prior treatment 1 START Insulin-naive Once-daily basal insulin Twice-daily NPH 1:1 unit conversion to start 80% of total daily NPH dose 1/3 to 1/2 of the total daily insulin dose 0.2 Units/kg for Initial dose of Toujeo® Type 1 Type 2 As a general rule, 0.2 to 0.4 units of insulin per kilogram of body weight can be used to calculate the initial total daily insulin dose in insulin naïve patients with type 1 diabetes. Mealtime insulin should be used to satisfy the remainder of the daily insulin requirements. Dosing & Titration for Toujeo® How to initiate and titrate to individualized goal1 • Adjust dose according to patient’s FPG goal1 • ADA recommends goals be individualized according to patient needs Continue reading >>

Lantus Titration

Lantus Titration

Member T2 since 1992, Lantus and Humalog since 2012 I was diagnosed with T2 about 10 years ago and have been on a variety of meds at different times since then (Metformin, Avandia, Actos, Prandin and Januvia). About 3 weeks ago my MD and I came to the conclusion that the oral meds were just not effective enough any more (consistent fasting glucose reading in the 170-190 range) and I started on Lantus (plus Metformin and Actos). My doctor decided to start me on 10 units of Lantus and then if the fbg was >150 after 5 days to bump it up to 12 units and if still >150 after 5 more days bump it up to 14 units. If still > 150 then contact her for further instructions. After 3-4 days it was obvious 10 units was doing nothing useful so I went to 12 units for a few days, but still nothing useful as far as my glucose levels are concerned. Being the adventurous sort, I modified the titration schedule to adjust by 4 units after 3 days until things started moving into the correct range. It is looking like the right dosage is probably going to be around 37-39 units based on the accelerated titration schedule I adopted. (going by the prescribed schedule it would have taken weeks to get here). I'll be contacting the doc at the end of next week to give her an update. I'm curious what sort of Lantus adjustment/titration schedule others have gone through to zero in on the correct dose. D.D. Family T1 since 1966, pumper since '03, transplant '08 Things may be different for type 2s, but as a type 1 I never adjusted my insulin by more than 2 units at a time. And then it was a minimum of 3 days between dosing changes to see if there was any effect. While it may take a bit more time, things are not always linear and you may find a tipping point and suddenly find yourself much too low with too Continue reading >>

Insulin Management Of Type 2 Diabetes Mellitus

Insulin Management Of Type 2 Diabetes Mellitus

Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. Insulin is secreted continuously by beta cells in a glucose-dependent manner throughout the day. It is also secreted in response to oral carbohydrate loads, including a large first-phase insulin release that suppresses hepatic glucose production followed by a slower second-phase insulin release that covers ingested carbohydrates 1 (Figure 12). Clinical recommendation Evidence rating References Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia. A 17–19 Fasting glucose readings should be used to titrate basal insul Continue reading >>

Aade In Practice // March 2014 // 35

Aade In Practice // March 2014 // 35

34 // AADE IN PRACTICE // March 2014 c CAPSULES | CLINICAL MATTERS AADE IN PRACTICE // March 2014 // 35 Over the past decade or two, insulin treatment options have come a long way. The development of so many new insulin preparations has made it easier for providers to successfully fine-tune regimens to meet each patient’s needs. Stud- ies have shown that for those on multiple daily injections, or even basal insulin alone, use of long-acting insulin preparations (ie, glargine and detemir) has yielded better glucose control throughout the entire day with fewer doses, less weight gain, and less hypoglycemia (Mavrogiannaki & Migdalis, 2012; Monami, Marchionni, & Mannucci, 2009). Using standardized treat-to-target algorithms, clinicians are able to ef- fectively titrate basal doses based on the fasting plasma glucose (FPG). If FPG values are consistently above target, then the daily basal dose is increased per protocol; if below target, the dose is decreased, and so on, until the FPG is consistently within target range. A sample treat-to-target algorithm, based on the AT.LANTUS trial (Davies, Storms, Shutler, Blanchi-Biscay, & Gomis, 2005) is provided in Figure 1. Basal Insulin Titration: Looking Beyond the Fasting Glucose TAMARA J. SWIGERT, MSN, RN, CDE Treat-to-Target Algorithm for Basal Insulin Titration Starting Dose: 10 units glargine daily at HS FPG goal: < 100 mg/dL Instructions: Review FPG patterns in-person or via telephone consultation. Calculate mean of last three FPG readings and adjust accordingly: Mean FPG for previous three days ≥ 100 mg/dL and < 120 mg/dL ≥ 120 mg/dL and < 140 mg/dL ≥ 140 mg/dL and < 180 mg/dL ≥ 180 mg/dL Increase daily basal dose by… 0 to 2 units (at provider’s discretion) 2 units 4 units 6 to 8 un Continue reading >>

100/33 (insulin Glargine And Lixisenatide Injection) 100 Units/ml And 33 Mcg/ml

100/33 (insulin Glargine And Lixisenatide Injection) 100 Units/ml And 33 Mcg/ml

Important Safety Information for SOLIQUA® 100/33 (insulin glargine and lixisenatide injection) 100 Units/mL and 33 mcg/mL Contraindications During episodes of hypoglycemia. In patients with known hypersensitivity to the active substance(s) or to any of the product components. Warnings and Precautions Anaphylaxis and Serious Hypersensitivity Reactions: In clinical trials of lixisenatide, there have been cases of anaphylaxis and other serious hypersensitivity reactions including angioedema. Severe, life-threatening, generalized allergic reactions, including anaphylaxis and angioedema, can occur with insulins, including insulin glargine. If hypersensitivity reactions occur, discontinue SOLIQUA 100/33. Use caution in patients with a history of anaphylaxis or angioedema with another GLP-1 RA because it is unknown whether such patients will be predisposed to anaphylaxis. Pancreatitis: Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 RAs. Cases of pancreatitis were reported in clinical trials of lixisenatide. After initiation of SOLIQUA 100/33, observe patients for signs and symptoms of pancreatitis (e.g., persistent severe abdominal pain, sometimes radiating to the back and which may be accompanied by vomiting). If pancreatitis is suspected, SOLIQUA 100/33 should promptly be discontinued. If pancreatitis is confirmed, restarting SOLIQUA 100/33 is not recommended and other antidiabetic therapies should be considered. Never Share a SOLIQUA 100/33 SoloStar® Pen between Patients: Pen-sharing poses a risk for transmission of blood-borne pathogens, even if the needle is changed. Do not withdraw SOLIQUA 100/33 from the pen with a syringe. Hyperglycemia or Hypoglycemia with Changes in Insulin Continue reading >>

Lantus Dosing

Lantus Dosing

Well, I never thought I’d say this, but it’s a great week to be a person with Type 1 diabetes. With all of the bad news surrounding the Type 2 drug Avandia (rosiglitazone), it’s a relief to know I don’t have to worry about it. I recommended you read my colleague Tara’s blog entry (“Type 2 Drug Avandia Linked to Increased Risk of Heart Attacks”) for the full story. That’s one of the first times in my life I’ve referred to someone as a colleague. What can I say? It’s just not a word in my describe-a-friend/coworker vocabulary. While all of the controversy surrounds Avandia, I’m way over in Type 1 land contemplating whether or not to lower my daily dose of Lantus (insulin glargine). I’ve just started a brand new bottle of Lantus and I’ve been taking my normal 15 units in the morning and then eating a rather normal breakfast and lunch, but I’m still going low in the midmorning and early afternoon. This happened Monday after eating Brussels sprouts and whole-wheat pasta for lunch and only taking one unit of rapid-acting NovoLog (insulin aspart) to help out the Lantus. I’ve known for a while that my body is sensitive to insulin, but lately it’s been a little more sensitive than usual. I took 13 units of Lantus yesterday and my blood glucose was 86 mg/dl before lunch. I often wonder how much of an adjustment two units of Lantus is. While I’m very much locked in on an insulin-to-carbohydrate ratio with my NovoLog, it’s a bit tricky to judge how much the longer-lasting insulins affect your blood glucose. Is there a chart for your Lantus dose? I seem to remember something from when I was diagnosed. I wonder what Google will tell me to do. I realize that Lantus doesn’t have a true peak the way some of the other insulins do, but sometimes it su Continue reading >>

Levemir® (insulin Detemir [rdna Origin] Injection) Indications And Usage

Levemir® (insulin Detemir [rdna Origin] Injection) Indications And Usage

Levemir® is contraindicated in patients with hypersensitivity to Levemir® or any of its excipients. Never Share a Levemir® FlexTouch® Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens. Dosage adjustment and monitoring: Monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment of concomitant anti-diabetic treatment. Administration: Do not dilute or mix with any other insulin or solution. Do not administer subcutaneously via an insulin pump, intramuscularly, or intravenously because severe hypoglycemia can occur. Levemir® (insulin detemir [rDNA origin] injection) is indicated to improve glycemic control in adults and children with diabetes mellitus. Levemir® is not recommended for the treatment of diabetic ketoacidosis. Intravenous rapid-acting or short-acting insulin is the preferred treatment for this condition. Levemir® is contraindicated in patients with hypersensitivity to Levemir® or any of its excipients. Never Share a Levemir® FlexTouch® Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens. Dosage adjustment and monitoring: Monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in the insulin dose or an adjustment of concomitant anti-diabetic treatment. Administration: Do not dilute or mix with any other insulin Continue reading >>

Interactive Dosing Calculator

Interactive Dosing Calculator

Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>

Common Standards Of Basal Insulin Titration In T2dm

Common Standards Of Basal Insulin Titration In T2dm

Go to: Treatment of T2DM: What Do Diabetes Guidelines Recommend? Quite a number of national4–7 and international 8–10 guidelines on the treatment of T2DM exist. Apart from those published by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the International Diabetes Federation (IDF), which presumably represent the most influential guidelines within the diabetes community, other guidelines, e.g., those of the World Health Organization, the National Institute for Health and Clinical Excellence (NICE), or the Scottish Intercollegiate Guidelines Network (SIGN), are also well-known and respected. All guidelines give recommendations on glycemic targets for T2DM [hemoglobin A1c (HbA1c), blood glucose values], on blood glucose self-monitoring by the patients, and on therapeutic options, including specific treatment regimens. The aforementioned guidelines, however, vary considerably—not only in size and scope, but also with regard to time and mode of insulin initiation and with regard to targets (HbA1c). While the EASD, the IDF, and the German Diabetes Association in their evidence-based guidelines refer to a target HbA1c <6.5%, the ADA and the IDF recommend a target HbA1c <7.0%, and the SIGN recommends a cutoff of 7.0%. The NICE sets the highest glycemic target, with an HbA1c <7.5%. The latest ADA/EASD position statement on the management of hyperglycemia in T2DM8 emphasizes a flexible patient-centered treatment approach: “Ultimately, it is patients who make the final decisions regarding their lifestyle choices and, to some degree, the pharmaceutical interventions they use; their implementation occurs in the context of the patients’ real lives and relies on the consumption of resources (both public and private). Continue reading >>

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