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STATE-OF-THE-ART PAPER

Defining the Role of Basal and Prandial Insulin for Optimal Glycemic Control

Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts

Manuscript received April 7, 2008; revised manuscript received November 4, 2008, accepted November 6, 2008.

^_* Reprint requests and correspondence: Dr. Edward S. Horton, Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts 02215 (Email: edward.horton{at}joslin.harvard.edu).

Type 2 diabetes mellitus is a progressive disease characterized by early impairment of beta-cell function and ultimately loss of beta-cell mass. Hence, a single daily injection of a long-acting insulin is commonly initiated after intensification of oral antihyperglycemic therapy. Hemoglobin A1C should be measured every 3 months and therapy adjusted if the target is not met. As beta-cell function continues to decline, it is often necessary to add exogenous bolus insulin therapy, using short-acting insulin analogs or regular insulin. Alternatively, the use of pre-mixed insulin preparations, combining both long-acting and short-acting insulins, may be used.

Key Words: diabetes • hemoglobin A1C • hyperglycemia • insulin

Abbreviations and Acronyms   A1C = hemoglobin A1C   CI = confidence interval   CV = cardiovascular   HR = hazard ratio   MI = myocardial infarction   OAD = oral antihyperglycemic drug   T2DM = type 2 diabetes mellitus   TZD = thiazolidinedione

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