Insulin for type 2 diabetes: choosing a second-line insulin regimen

Anthony Barnett, A Begg, P Dyson, M Feher, S Hamilton, N Munro

Research output: Contribution to journalArticle

22 Citations (Scopus)


Guidance has been published on the choice of initial insulin regimen for patients with type 2 diabetes [NPH (isophane) insulin or a long-acting insulin analogue] but not on how to choose a second regimen when glycaemic control becomes unsatisfactory. Aims: To develop pragmatic clinical guidance for choosing a second-line insulin regimen tailored to the individual needs of patients with type 2 diabetes after failure of first-line insulin therapy. Methods: Formulation of a consensus by expert panel based on published evidence and best clinical practice, taking into account patient preferences, lifestyle and functional capacity. Results: Six patient-dependent factors relevant to the choice of second-line insulin regimen and three alternative insulin regimens (twice-daily premixed, basal-plus and basal-bolus) were identified. The panel recommended one or more insulin regimens compatible with each factor, emphasising the fundamental importance of a healthy lifestyle that includes exercise and weight reduction. These recommendations were incorporated into an algorithm to provide pragmatic guidance for clinicians. Conclusion: The three alternative insulin regimens offer different benefits and drawbacks and it is important to make the right choice to optimise outcomes for patients.
Original languageEnglish
Pages (from-to)1647-1653
Number of pages7
JournalInternational Journal of Clinical Practice
Issue number11
Publication statusPublished - 1 Nov 2008


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