Diabetes Metab J.  2017 Oct;41(5):367-373. 10.4093/dmj.2017.41.5.367.

Insulin Therapy for Adult Patients with Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association, 2017

• Lee BW
• Kim JH
• Ko SH
• Hur KY
• Kim NH
• Rhee SY
• Kim HJ
• Moon MK
• Park SO
• Choi KM
• Committee of Clinical Practice Guideline of Korean Diabetes Association

• KMID: 2392479
• DOI: http://doi.org/10.4093/dmj.2017.41.5.367

Abstract

The Korean Diabetes Association (KDA) has regularly updated its Clinical Practice Guidelines. In 2017, the KDA published a position statement on the use of antihyperglycemic agents for patients with type 2 diabetes mellitus (T2DM). Growing evidence from new multinational clinical trials using novel and traditional insulin analogues has also been accumulated. Following global trends, many results of clinical trials, especially concerning the clinical efficacy and safety of insulin therapy, have been published about Korean patients with T2DM. After a systematic search of recent evidence, the KDA updated and modified its clinical practice recommendations regarding the initiation, choice, and intensification of insulin and created an insulin treatment algorithm for the first time to guide physicians caring for adult Korean patients with T2DM.

Keyword

Clinical practice guideline; Diabetes mellitus, type 2; Hypoglycemic agents; Insulin; Korea

MeSH Terms

Adult*
Diabetes Mellitus, Type 2*
Humans
Hypoglycemic Agents
Insulin*
Korea
Treatment Outcome
Hypoglycemic Agents
Insulin

Figure

• 

  Fig. 1 Treatment algorithm for insulin therapy. (A) Initiation of insulin treatment. If the initial glycosylated hemoglobin (A1C) level is >9.0% and symptomatic hyperglycemia or metabolic decompensation is present, insulin therapy can be initiated with or without oral antihyperglycemic agents (OHAs) in patients with newly diagnosed type 2 diabetes mellitus (T2DM). If the A1C target range is not achieved after implementing a basal insulin regimen, then proceed to intensification treatment, for example, addition of a glucagon-like peptide 1 receptor agonist (GLP-1RA) or a prandial insulin or switching to a premixed insulin regimen. (B) For adult patients with T2DM who have not achieved their glycemic target following adequate treatment using OHAs. When OHAs fail, proceed to basal insulin either with or without OHAs. The addition of a GLP-1RA or switching to a premixed insulin regimen could be another option depending on the patient's clinical situation. The width of each black line reflects the strength of the expert consensus recommendations. Adapted from Ko et al. [31].

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