Clinical Diabetes Digital Publication
Effective Initiation and Treatment With Basal Insulin in People With Type 2 Diabetes: Focus on Mitigating Hypoglycemia in Patients at Increased Risk
John Anderson, MD, Frist Clinic, Nashville, Tennessee; Paresh Dandona, MD, PhD, Division of Endocrinology, Diabetes and Metabolism, University of Buffalo, The State University of New York, Buffalo, New York; Geralyn R. Spollett, MSN, ANP, CDE, Yale University Diabetes Center, New Haven, Connecticut; and Scott Urquhart, PA-C, DFAAPA, Diabetes and Thyroid Associates, Fredericksburg, Virginia
Many people with type 2 diabetes are treated with insulin with the goal of achieving a specific A1C target. In this short video series, an expert panel moderated by John Anderson, MD, discusses approaches to optimizing basal insulin initiation and treatment in people with type 2 diabetes, including those patients most at risk (e.g., those with renal impairment and older adults), with a focus on reaching A1C goals while mitigating the risk for hypoglycemia.
The panel discusses how considerations for the management of hypoglycemia are important in these patients. When used appropriately, the risk of hypoglycemia with basal insulin analogs can be reduced while still achieving individualized glycemic goals.
The videos can be viewed in their entirety below, and an executive summary of the panel’s recommendations is available on the Clinical Diabetes website at https://doi.org/10.2337/cd20-0035 or by clicking the thumbnail to the left.
This peer-reviewed publication was developed in adherence with Good Publication Practice (GPP3) guidelines. All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship and have disclosed all potential conflicts of interest.
About the Authors
John Anderson, MD, received his Bachelor of Arts with high distinction, Phi Beta Kappa, at the University of Virginia and his Internal Medicine medical degree and residency at Vanderbilt University. Dr. Anderson practices internal medicine and diabetes at the Frist Clinic in Nashville, Tennessee. He is Past President of the 38-member multi-specialty clinic, and has served leadership roles at Centennial Medical Center, a 670-bed HCA tertiary care referral hospital. He has served as Chair of the Department of Medicine for two separate terms and has been a member and Chair of the Board of Trustees of Centennial. He has received numerous honors including recognition as a "Top Doctor", Nashville Business Journal 2010-2017 and Honorary Fellow of India College of Physicians and Doctor of Humane Letters, New York College of Podiatric Medicine.
Dr. Anderson is Past President, Medicine & Science of the American Diabetes Association (ADA) and has served two separate terms on the National Board of Directors, as well as three years on the Executive Committee. Dr. Anderson has been an ADA volunteer for more than 25 years, both locally and nationally. He has participated on multiple committees and task forces, including Chair of the Advocacy Committee and Co-Chair of the ADA’s Health Reform Task Force, among others. In 2013, Dr. Anderson received the Banting Medal for Scientific Achievement, the highest scientific award of the ADA, for his service as President of Medicine & Science.
In addition to his primary care practice, Dr. Anderson continues to consult and lecture both nationally and internationally, with a focus on improving the care of people with diabetes in the primary care setting. He has authored numerous publications in The Journal of Family Practice, Diabetes Therapy, Diabetes Care, Clinical Diabetes, and Postgraduate Medicine.
Paresh Dandona, MD, PhD, is a Rhodes Scholar from India, trained at the University of Oxford and the University of London, U.K.
Dr. Dandona is a Distinguished Professor of Medicine and chief of the Division of Endocrinology, Diabetes and Metabolism, at the University at Buffalo, The State University of New York. He is also the founder and director of the Diabetes–Endocrinology Center of Western New York in Buffalo. He received the Valor Award of the American Diabetes Association for his contributions to the standards of care in diabetes and the establishment of a network of diabetes care in Western New York.
Dr. Dandona received the Pharmacia-Pfizer/Endocrine Society Award for the discovery of the anti-inflammatory effect of insulin. This discovery has extended into potential cardio-protective and neuro-protective effects of insulin in acute myocardial infarction, stroke, and Alzheimer’s disease. His work on obesity, oxidative stress and inflammation, and the pro-inflammatory effects of macronutrients (foods) is now recognized globally. He has recently been awarded with the largest grant ever from the Juvenile Diabetes Research Foundation to investigate the effect of "triple therapy" in patients with type 1 diabetes.
With more than 590 publications in peer-reviewed medical journals, Dr. Dandona has presented keynote lectures on diabetes and insulin resistance at many national and international conferences. He is the founding editor of Metabolic Syndrome and Related Disorders, and is or has been on the editorial boards of the Journal of Clinical Endocrinology and Metabolism, Diabetes Care, Current Diabetes Reviews, and Journal of Diabetes.
Geralyn R. Spollett, MSN, ANP, CDE, holds a master of science degree in nursing with distinction from Boston College, Chestnut Hill, Massachusetts. She has served on the boards of several professional organizations, most notably as Chair of the National Certification Board for Diabetes Educators (NCBDE) and the Executive Board of the American Diabetes Association (ADA) 2009-2012, and President for Health Care and Education in 2012.
Ms. Spollett has held a variety of leadership positions at the regional ADA and served as a chairperson of the CT Health Care Professionals Diabetes Symposium for seven years. In 2006, she was honored as Outstanding Diabetes Educator by the ADA. In 2012, she received the ADA CT Award for Clinical Excellence. She has served as Associate Editor for the journals Diabetes Spectrum and Practical Diabetology as well as the ADA book, The Complete Nurses Guide for Diabetes, now in its third edition. She has authored more than 45 publications addressing diabetes care and management.
For 10 years, Ms. Spollett was an Associate Professor at Yale University School of Nursing in the Adult and Family Nurse Practitioner Program and was instrumental in developing the Diabetes Care Concentration specialty. Although retired from full-time practice, she remains involved in the direct care of persons with diabetes specializing in the use of various insulin and sensor technologies. Ms. Spollett has lectured widely nationally and internationally on both type 1 and type 2 diabetes from a nurse practitioner perspective.
Scott Urquhart, PA-C, DFAAPA, is a graduate of The George Washington University PA program. He received his master’s degree, with a specialization in endocrinology, from the University of Nebraska Medical Center in Omaha, Nebraska.
Mr. Urquhart practices endocrinology at Diabetes and Thyroid Associates, in Fredericksburg, Virginia. He is a clinical instructor at the George Washington University School of Medicine and Health Sciences, in Washington, DC, and an adjunct clinical professor at James Madison University, in Harrisonburg, Virginia.
Mr. Urquhart is a founding member and Past President of the American Society of Endocrine Physician Assistants. He is a distinguished fellow of the American Academy of Physician Assistants, a member of the Virginia Academy of Physician Assistants. He served on the Task Force Committee for the American Association of Clinical Endocrinologists for the Education of Allied Health Professionals. In 2011, he founded and developed the nation’s first annual PA/NP - Metabolic and Endocrine Disease Summit (MEDS). He currently serves as the Chair for this ongoing biannual summit.
Mr. Urquhart has published in many peer-reviewed journals including the Journal of the American Academy of Physician Assistants, Diabetes Spectrum, Clinical Diabetes, and Clinician Reviews. He is on the editorial advisory board for Clinician Reviews and presents nationally on a variety of endocrine diseases and topics.
Disclosures
John Anderson, MD—Consultant/Advisory Boards: Abbott, AstraZeneca, Eli Lilly, Janssen, Mannheim, Merck, Novo Nordisk, Sanofi; Speaker’s bureau: AstraZeneca, Eli Lilly, Janssen, Novo Nordisk, Sanofi
Paresh Dandona, MD, PhD—Consultant or Advisory Board: AstraZeneca, Novo Nordisk; Investigator: AstraZeneca, Novo Nordisk, Sanofi; Meeting participant/lecturer: AstraZeneca, Novo Nordisk
Geralyn Spollett, MSN, ANP, CDE—Consultant or Speaker’s bureau: Eli Lilly and Company, Sanofi
Scott Urquhart, PA-C, DFAAPA—Speaker’s bureau: AstraZeneca, Dexcom, Novo Nordisk; Advisory Board: AstraZeneca, Dexcom, Sanofi; Consultant: Novo Nordisk
Acknowledgements
The authors received writing/editorial support in the preparation of the video materials from Karen Pemberton, Evidence Scientific Solutions, Inc, Philadelphia, PA, USA, funded by Sanofi US Inc, Bridgewater, NJ, USA.
Financial support provided by