When to Initiate Basal Insulin?
Practical Guidance based on the 2022 ADA/EASD Guidelines.
The 2022 guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) provide evidence-based recommendations on managing type 2 diabetes, focusing on the use of basal insulin when patients fail to achieve glycemic control through other methods. The article outlines when and how to initiate basal insulin, offering practical steps for general practitioners (GPs) to implement these strategies effectively.
Watch the video below or read the summary including selected highlights from the guidelines, and a link to the full overview.
ADA video
When to Initiate Basal Insulin?
The ADA/EASD 2022 guidelines recommend considering basal insulin for type 2 diabetes patients who are unable to achieve adequate glycemic control (generally an HbA1c above 7.0%) despite the use of multiple oral agents or GLP-1 receptor agonists. For GPs, this typically involves monitoring patients with consistently elevated fasting plasma glucose levels (over 13.9 mmol/L) or an HbA1c level exceeding 86 mmol/mol (10%), as well as those presenting with symptoms of catabolism (e.g., weight loss, increased thirst, and urination).
The guidelines suggest that GPs initiate basal insulin with a long-acting preparation, starting at a low dose (e.g., 10 IU daily or 0.1–0.2 IU/kg/day). Close monitoring and gradual titration based on fasting glucose levels (aiming for 4.4-7.2 mmol/L) help minimize the risk of hypoglycemia. GPs are encouraged to adapt this approach to each patient, considering factors like age, duration of diabetes, other medical conditions, and the individual’s lifestyle.
Hearing from diabetes experts
Clinical Implications for General Practice
The updated guidelines highlight the importance of early and individualized interventions for GPs managing type 2 diabetes patients. Starting basal insulin when oral therapies are insufficient helps maintain glycemic targets and prevents complications such as cardiovascular issues, neuropathy, and retinopathy. GPs should remain proactive in monitoring progress, adjusting doses, and providing patient education on insulin management to optimize care outcomes.
For further details and guidance, consult the full 2022 ADA/EASD guidelines available here.
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Referenties
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American Diabetes Association & European Association for the Study of Diabetes. (2022). Standards of medical care in diabetes—2022. Diabetes Care, 45(Supplement 1), S1-S264. https://doi.org/10.2337/dc22-SINT
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