a Department of Family and Community Medicine , University of North Dakota , Grand Forks , ND , USA.
b National Research Institute , Los Angeles , CA , USA.
Postgrad Med. 2018 May;130(4):365-374. doi: 10.1080/00325481.2018.1452515. Epub 2018 Mar 23.
The alarming rise in the number of people living with type 2 diabetes (T2D) presents primary care physicians with increasing challenges associated with long-term chronic disease care. Studies have shown that the majority of patients are not achieving or maintaining glycemic goals, putting them at risk of a wide range of diabetes-related complications. Disease- and self-management programs have been shown to help patients improve their glycemic control, and are likely to be of particular benefit for patients with diabetes dealing with these issues. Anticipatory guidance is an individualized, proactive approach to patient education and counseling by a health-care professional to support patients in better coping with problems before they arise. It has been shown to improve disease outcomes in a variety of chronic conditions, including diabetes. While important at all stages, anticipatory guidance may be of particular importance during changes in treatment regimens, and especially during transition to, and escalation of, insulin-based regimens. The aim of this article is to provide advice to physicians on anticipatory guidance for basal-insulin dosing, focusing on appropriate basal-insulin-dose increase and prevention of potentially deleterious basal-insulin doses, so called overbasalization. It also provides an overview of new treatment options for patients with T2D who are not well controlled on basal-insulin therapy, fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonists, and advice on the type of anticipatory guidance needed to ensure safe and appropriate switching to these therapies.
2 型糖尿病（T2D）患者人数的惊人增长给初级保健医生带来了与长期慢性疾病护理相关的日益严峻的挑战。研究表明，大多数患者未能达到或维持血糖目标，使他们面临各种与糖尿病相关的并发症的风险。疾病和自我管理计划已被证明有助于患者改善血糖控制，对于正在应对这些问题的糖尿病患者可能特别有益。预期指导是一种由医疗保健专业人员对患者进行个性化、主动的教育和咨询方法，以支持患者在问题出现之前更好地应对问题。它已被证明可以改善各种慢性疾病的预后，包括糖尿病。虽然在所有阶段都很重要，但预期指导在治疗方案的变化时，尤其是在转向和增加基于胰岛素的治疗方案时，可能特别重要。本文的目的是为医生提供关于基础胰岛素剂量的预期指导建议，重点是适当增加基础胰岛素剂量和预防潜在有害的基础胰岛素剂量，即过度基础化。它还概述了 T2D 患者的新治疗选择，这些患者在基础胰岛素治疗下控制不佳，基础胰岛素和胰高血糖素样肽-1 受体激动剂的固定比例组合，并就确保安全和适当转换为这些治疗所需的预期指导类型提供建议。
