When to Initiate Basal Insulin?

Watch the video below or read the summary including selected highlights from the guidelines, and a link to the full overview.

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.

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.