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Expert panel guidance and narrative review of treatment simplification of complex insulin regimens to improve outcomes in type 2 diabetes

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Jude, Edward B., Malecki, Maciej T., Gomez Huelgas, Ricardo, Prazny, Martin, Snoek, Frank, Tankova, Tsvetalina, Giugliano, Dario, Khunti, Kamlesh·2022·Diabetes Therapy
DOI 10.1007/s13300-022-01222-2PMC PMC8913205
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Abstract

Given the progressive nature of type 2 diabetes (T2D), most individuals with the disease will ultimately undergo treatment intensification. This usually involves the stepwise addition of a new glucose-lowering agent or switching to a more complex insulin regimen. However, complex treatment regimens can result in an increased risk of hypoglycaemia and high treatment burden, which may impact negatively on both therapeutic adherence and overall quality of life. Individuals with good glycaemic control may also be overtreated with unnecessarily complex regimens. Treatment simplification aims to reduce individual treatment burden, without compromising therapeutic effectiveness or safety. Despite data showing that simplifying therapy can achieve good glycaemic control without negatively impacting on treatment efficacy or safety, it is not always implemented in clinical practice. Current clinical guidelines focus on treatment intensification, rather than simplification. Where simplification is recommended, clear guidance is lacking and mostly focused on treatment of the elderly. An expert, multidisciplinary panel evaluated the current treatment landscape with respect to guidance, published evidence, recommendations and approaches regarding simplification of complex insulin regimens. This article outlines the benefits of treatment simplification and provides practical recommendations on simplifying complex insulin treatment strategies in people with T2D using illustrative cases.

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  • Simplification of the insulin plan to match an individual's self-management abilities and available social and medical support reduces hypoglycemia and disease-related distress without worsening glycemic outcomes.

    “Simplification of the insulin plan to match an individual's self-management abilities and their available social and medical support in these situations has been shown to reduce hypoglycemia and diseaserelated distress without worsening glycemic outcomes (100-103).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [103]

    In 'Current Evidence and Treatment Landscape' (page unavailable), the review reports that a trial in older people with type 2 diabetes found reduced hypoglycaemia risk and diabetes-related stress after simplification, without compromising glycaemic control. Its 'Personalisation of Care and Psychosocial Aspects Are the Key Drivers' section recommends considering cognitive abilities and involving caregivers, but the reported outcome evidence is limited to older adults and does not establish that matching a plan to available social and medical support produced those benefits. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Simplification of the insulin plan to match an individual's self-management abilities and their available social and medical support reduces hypoglycemia and disease-related distress without worsening glycemic outcomes.

    “Simplification of the insulin plan to match an individual's self-management abilities and their available social and medical support in these situations has been shown to reduce hypoglycemia and disease-related distress without worsening glycemic outcomes (107-110).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [110]

    In “Current Evidence and Treatment Landscape” (page unavailable), the review reports a trial in older people with type 2 diabetes in which simplification reduced hypoglycaemia risk and diabetes-related stress without compromising glycaemic control. Its “Personalisation of Care and Psychosocial Aspects” section recommends considering cognitive capabilities and caregivers, but the reported outcome finding is limited to older people and does not establish that matching a plan to available social and medical support produced those benefits. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Simplification of the insulin plan to match an individual's self-management abilities and available social and medical support is associated with reduced hypoglycemia and disease-related distress without worsening glycemic outcomes.

    “Studies suggest that simplification of the insulin plan to match an individual’s self-management abilities and their available social and medical support is associated with reduced hypoglycemia and disease-related distress without worsening glycemic outcomes”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [152]

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Cited by

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Authors
Jude, E. B., Malecki, M. T., Gomez Huelgas, R., Prazny, M., Snoek, F., Tankova, T., Giugliano, D., & Khunti, K.
Affiliations
  • University of Manchester (GB)
  • Jagiellonian University (PL)
  • Amsterdam University Medical Centers (NL)
  • Medical University of Sofia (BG)
  • University of Campania "Luigi Vanvitelli" (IT)
  • University of Leicester (GB)
Corresponding author
Khunti, Kamlesh
ORCID
Venue
Diabetes Therapy
Publisher
Springer Science and Business Media LLC
Published
2022-03-11
Volume
13
Issue
4
Pages
619-634
ISSN
  • 1869-6953 (ISSN-L)
  • 1869-6961
DOI
10.1007/s13300-022-01222-2
PMC
PMC8913205
OpenAlex
W4220970001
Cited by
52
References
17
Citations by year
2026: 7 · 2025: 13 · 2024: 12 · 2023: 13 · 2022: 7
FWCI
1.60
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Therapy (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, cc-by)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion, cc-by-nc)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by-nc)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
Funders
Sanofi
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
type 2 diabetes, insulin regimens, treatment simplification, treatment intensification, hypoglycemia, treatment burden, glycemic control, overtreatment, clinical guidelines, expert panel recommendations

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