From the Guidelines
The most effective treatment for diabetes mellitus involves a combination of lifestyle modifications and medications, with metformin being the preferred initial pharmacologic agent for type 2 diabetes and insulin therapy being mandatory for type 1 diabetes. For type 2 diabetes, lifestyle changes are essential, including a balanced diet low in refined carbohydrates, regular physical activity (at least 150 minutes of moderate-intensity aerobic activity per week) 1, and weight management. If metformin alone is insufficient, additional medications may be added, such as SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, or sulfonylureas.
Key Considerations for Type 1 Diabetes
- Insulin therapy is mandatory, typically using a basal-bolus regimen with long-acting insulin (glargine, detemir) once daily and rapid-acting insulin (lispro, aspart) before meals 2.
- Blood glucose monitoring is crucial for all patients, with target HbA1c below 7% for most adults.
- Regular screening for complications (eye exams, kidney function tests, foot examinations) is necessary.
Key Considerations for Type 2 Diabetes
- Metformin is the preferred initial pharmacologic agent, due to its efficacy, safety, and potential to reduce the risk of cardiovascular events and death 1.
- A patient-centered approach should guide the choice of pharmacologic agents, considering factors such as efficacy, cost, potential side effects, and patient preferences 1.
- Lifestyle modifications, including physical activity and weight loss, are essential for achieving and maintaining glycemic control. Some of the key points to consider when treating diabetes mellitus include:
- The importance of individualizing treatment plans to meet the unique needs and preferences of each patient.
- The need for ongoing monitoring and adjustment of treatment plans to ensure optimal glycemic control and minimize the risk of complications.
- The potential benefits and risks of different medications and treatment approaches, and the importance of carefully weighing these factors when making treatment decisions. Overall, the goal of diabetes treatment is to achieve and maintain optimal glycemic control, while minimizing the risk of complications and improving quality of life. By working closely with patients and incorporating the latest evidence-based guidelines and recommendations, healthcare providers can help patients with diabetes achieve the best possible outcomes.
From the FDA Drug Label
In a study performed in 24 non-diabetic subjects with normal renal function (ClCr >80 mL/min), moderate renal impairment (30–50 mL/min), and severe renal impairment (<30 mL/min), the subjects with moderate and severe renal impairment had increased exposure to insulin glulisine by 29% to 40% and reduced clearance of insulin glulisine by 20% to 25% compared to subjects with normal renal function [see Use in Specific Populations (8.6)]. The safety and efficacy of APIDRA were studied in adult patients with type 1 and type 2 diabetes (n=1833) and in pediatric patients (4 to 17 years) with type 1 diabetes (n=572). A 26-week, randomized, open-label, active-controlled, non-inferiority study was conducted in patients with type 1 diabetes to assess the safety and efficacy of APIDRA (n=339) compared to insulin lispro (n=333) when administered subcutaneously within 15 minutes before a meal. A 26-week, randomized, open-label, active-controlled, non-inferiority study was conducted in insulin-treated patients with type 2 diabetes to assess the safety and efficacy of APIDRA (n=435) given within 15 minutes before a meal compared to regular human insulin (n=441) administered 30 to 45 minutes prior to a meal
The treatment of diabetes mellitus with glulisine (APIDRA) involves administering the medication subcutaneously within 15 minutes before a meal.
- Type 1 diabetes: APIDRA can be administered in combination with insulin glargine as the basal insulin.
- Type 2 diabetes: APIDRA can be administered in combination with NPH human insulin as the basal insulin. The medication has been shown to have similar efficacy to insulin lispro and regular human insulin in terms of glycemic control. Key points to consider when treating diabetes mellitus with glulisine include:
- Administering the medication subcutaneously within 15 minutes before a meal
- Using the medication in combination with a basal insulin, such as insulin glargine or NPH human insulin
- Monitoring glycated hemoglobin (GHb) levels to assess glycemic control 3
From the Research
Treatment Options for Diabetes Mellitus
- Insulin therapy is a common treatment for type 2 diabetes mellitus, with options including basal insulin, rapid-acting prandial insulin, and a combination of both (basal-bolus regimen) 4
- Insulin degludec is an ultra-long-acting insulin analogue with a flat and stable glucose-lowering profile, and can be co-formulated with prandial insulin aspart for sustained glycaemic control with less hypoglycaemia 4
- Other treatment options include insulin sensitizers, alpha-glucosidase inhibitors, secretagogues, and metformin, with a layered approach to treatment starting with insulin-sensitizer therapy and progressing to triple oral therapy and subcutaneous insulin as needed 5
Comparison of Insulin Therapies
- Insulin detemir and insulin glargine are long-acting insulin analogues with similar efficacy and safety profiles, but insulin detemir may be associated with less weight gain and insulin glargine with fewer injection site reactions 6
- The choice of insulin therapy depends on individual patient factors, including overall efficacy, adverse effect profile, cost, and patient preference 7
Novel Treatment Options
- New therapies for type 2 diabetes include glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 inhibitors, with ongoing research into novel targets and mechanisms for improved glycaemic control and reduced complications 8
- Emerging treatments include smart insulin preparations, adipokine adiponectin, hepatokine fibroblast growth factor (FGF) 21, and unimolecular peptides interacting with multiple receptors, offering potential for personalized approaches to glucose-lowering therapy 8