A Safe and Simple Algorithm for Adding and Adjusting Mealtime Insulin to Basal-Only Therapy

Numerous studies have shown that early initiation of intensive treatment significantly improves β-cell function and long-term glycemic control in individuals with type 2 diabetes (1–4). However, despite national and international clinical guidelines that recommend escalation of therapy if individualized glycemic targets are not met within 3–6 months (5), transition to basal-only insulin therapy and then to intensive insulin management is often delayed despite significant and sustained hyperglycemia. As reported by Khunti et al. (6), the time to treatment intensification from noninsulin medications to basal-only insulin therapy is often delayed by up to 7 years in adults with type 2 diabetes with A1C levels ≥8.0%, and the average time to transition of patients from basal-only insulin to basal-plus-mealtime insulin is 3.2 years.