Achieving glycaemic targets with basal insulin in T2DM by individualizing treatment

HbA1c goals should be individualized, particularly for patients who have a long history of type 2 diabetes mellitus, multiple comorbidities and a short life expectancyInsulin should be added where needed to achieve glycaemic control, and insulin can be chosen as a second-line therapy after treatment failure of metforminThe primary goal of insulin replacement is to mimic a normal physiological insulin response, which consists of basal insulin between meals and a boost of insulin at mealtimesAny type of insulin will lower HbA1c levels, but all types are associated with weight gain; risk of nocturnal and overall hypoglycaemia is lower for long-acting analogues than for neutral protamine Hagedorn insulinAs opposed to physician-driven instructions on increasing insulin dose, patients can be taught how to self-titrate insulin dosesBarriers to initiating insulin therapy include a wide range of obstacles relating to patients, providers and health-care systems