Moreover, a recent study of 552 Asian patients with poorly controlled T2D who were started on once-daily glargine showed that patient-led insulin titration resulted in significantly greater reductions in both HbA1c and fasting plasma glucose compared with physician-led titration. Interim data from a large prospective Chinese study (ORBIT) of approximately 20,000 individuals with T2D showed a significant decline in HbA1c values in 6 months, and many more patients were able to achieve target HbA1c when insulin therapy was initiated at or below HbA1c of 8.5%. Although this delay is likely due to the number of new drugs that provide an alternative to insulin, data from recent studies clearly suggest that early initiation of insulin therapy is beneficial. In subjects with T2D, there is a significant delay in initiating insulin therapy. A recent survey of individuals in their sixth decade of diabetes showed that 25% of respondents felt no symptoms of hypoglycemia until their blood glucose dropped to 40–49 mg/dL (2.2–2.7 mmol/L). Thus, we may want to consider fasting glucose as the initial target for control, especially in T2D (type 2 diabetes).īecause people with diabetes are living longer-nearly one in four individuals with diabetes is in their seventh or eighth decade of life-the problem of severe hypoglycemia is emerging as a leading health issue in the elderly with diabetes. Much of the morbidity and mortality seen in diabetes is related to cardiovascular disease, which is highly correlated with fasting plasma glucose. The most recent data show that the costs of diagnosed diabetes had risen by 41% between 20 however, the new classes of medications and supplies only account for 12% of medical expenditures.Īlthough there are trends toward significant reductions in the rates of diabetes-related complications, specifically microvascular disease, mortality in diabetes has significantly increased in both men and women when compared with the control group without diabetes because of the increasing prevalence.
It is estimated that there will be approximately 500 million individuals with diabetes within the next 10 years with resultant increases in costs. adults included in the T1D Exchange Registry ( ), only approximately 20% are reaching their glycated hemoglobin (HbA1c) targets.Īdditionally, worldwide prevalence of diabetes continues to increase far beyond expectations.
However, nearly half of individuals with diabetes still do not reach their targets for glycemic control. Since 1980, several new medications and devices have been added to the armamentarium for managing diabetes.
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