A large number of patients with type 2 diabetes (T2D) on basal insulin do not reach their glycosylated hemoglobin A1c (HbA1c) goals and require additional therapy to address postprandial hyperglycemia. Guidelines from expert bodies have outlined several approaches to accomplish post-prandial glucose (PPG) control, and recent literature suggests several more. This article provides strategies for primary care physicians caring for patients with T2D who do not achieve glycemic control with basal insulin alone. Current treatment guidelines and strategies for improving PPG control will be reviewed, including the efficacy, safety, and cost effectiveness of rapid-acting insulin (RAI) analogues, premixed insulin, glucagon-like protein 1 receptor agonists, dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, and alpha glucosidase inhibitors. Other approaches such as combinations of newer basal insulin plus RAI, and fixed-ratio combination of basal insulin and a GLP-1 receptor agonist are also described.

作者：Guillermo E, Umpierrez；Timothy S, Bailey；Danielle, Carcia；Charles, Shaefer；Jay H, Shubrook；Neil, Skolnik

来源：Journal of diabetes 2017 年