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Addition of a single short-acting insulin bolus to basal insulin-supported oral therapy: a systematic review of data on the basal-plus regimen
  1. Jochen Seufert1,
  2. Anja Borck2,
  3. Peter Bramlage3
  1. 1 Division of Endocrinology and Diabetoligy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  2. 2 Sanofi, Berlin, Germany
  3. 3 Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
  1. Correspondence to Professor Jochen Seufert; jochenseufert{at}uniklinik-freiburg.de

Abstract

We summarize here clinical and trial data on a once-daily administration of a single bolus to the meal with the largest expected postprandial glucose excursion (basal-plus), and comment on its clinical utility in the treatment of type 2 diabetes. A PubMed search of data published until September 2018 was taken into consideration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eighteen reports representing 15 studies were identified (age: 18–80 years; 50–890 patients; follow-up: 8 days to 60 weeks). Data suggest basal-plus is efficacious for improving glycemic control, with a low incidence of (severe) hypoglycemia and minor increases in bodyweight. The timing of short-acting insulin administration and use of different monitoring/titration approaches appear to have minimal impact. When compared with premixed insulin, basal-plus results in largely comparable outcomes. Compared with basal-bolus, it may result in non-inferior glycemic improvements with less weight gain, less hypoglycemia and fewer daily injections. A basal insulin/glucagon-like peptide-1 receptor agonist fixed ratio combination may offer several advantages over the basal-plus regimen, at the cost of gastrointestinal side effects. We conclude that the stepwise introduction of short-acting insulin via the basal-plus strategy represents a viable alternative to a full basal-bolus regimen and may help to overcome barriers associated with multiple injections and anticipated complexity of the insulin regimen.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors PB and JS drafted the first version of the manuscript and all authors revised the article for important intellectual content. All authors approved the final version for publication.

  • Funding Sanofi Aventis Deutschland GmbH supported the systematic literature search underlying this article.

  • Competing interests JS has attended Speaker’s Bureaux for AstraZeneca, Bristol-Myers Squibb, Bayer Healthcare, Berlin Chemie, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Lifescan, Merck Sharp & Dohme, Mundipharma, Novartis, Novo Nordisk, Pfizer, Sanofi and Takeda. PB has received research funding and honoraria for consultancy from AstraZeneca, Bristol-Myers Squibb, Novartis and Sanofi. AB is an employee of Sanofi.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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