BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion.

Abstract

The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring.Funding: Sanofi.

• Authors: Sarita Bajaj, A K Das, Sanjay Kalra, Rakesh Sahay, Banshi Saboo, Sambit Das, M Shunmugavelu, Jubbin Jacob, Gagan Priya, Deepak Khandelwal, Deep Dutta, Manoj Chawla, Vineet Surana, Mangesh Tiwaskar, Ameya Joshi, Pradip Krishna Shrestha, Jyoti Bhattarai, Bishwajit Bhowmik, Tint Swe Latt, Than Than Aye, G Vijayakumar, Manash Baruah, Fatema Jawad, A G Unnikrishnan, Subhankar Chowdhury, Md Faruqe Pathan, Noel Somasundaram, Manilka Sumanathilaka, Abbas Raza, Silver K Bahendeka, Ankia Coetzee, Sundeep Ruder, Kaushik Ramaiya, Roberta Lamptey, Charlotte Bavuma, Khalid Shaikh, Andrew Uloko, Sandeep Chaudhary, Abdurezak Ahmed Abdela, Zhanay Akanov, Joel Rodrìguez-Saldaña, Raquel Faradji, Armindo Tiago, Ahmed Reja, Leszek Czupryniak
• Journal: Diabetes therapy : research, treatment and education of diabetes and related disorders (Diabetes Ther) Vol. 10 Issue 4 Pg. 1189-1204 (Aug 2019) ISSN: 1869-6953 [Print] United States
• PMID: 31102253 (Publication Type: Journal Article, Review)