Complementary Approaches to Improving Glucose Control-Insulin and Incretins: Patient Case Studies in Action.

Purpose: The use of insulin and incretin-based therapies together has recently emerged as a new therapeutic option for patients with type 2 diabetes. This approach can be used across the continuum of diabetes and is supported by clinical trial evidence. To illustrate how these data may apply to clinical care, this supplement uses patient case studies to provide clinical context for diabetes educators. Relevant medical literature was searched and cited. Search terms included insulin, DPP-4 inhibitors, GLP-1 receptor agonists, hypoglycemia, and weight gain.

Conclusion: Insulin remains the most potent glucose-lowering agent available for the treatment of type 2 diabetes but has limitations, primarily of hypoglycemia and secondarily of weight gain. The addition of incretin-based therapies complements the glucose-lowering potential of basal insulin, without increasing the risk of hypoglycemia, potentially allowing for lower doses of insulin and without increasing weight gain (DPP-4 inhibitors) or possibly with weight loss (GLP-1 receptor agonists). Incretin-based therapies offer advantages over prandial insulin to address postprandial hyperglycemia.