Basal Insulin Treatment Strategies in Diabetes Management

Basal insulin therapy seeks to replicate the continuous, low-level secretion of insulin by a healthy pancreas, thereby stabilising fasting glucose concentrations and reducing glycaemic variability. Traditional preparations such as Neutral Protamine Hagedorn insulin have largely been supplanted by long-acting analogues designed for once-daily administration, including insulin glargine and insulin detemir. More recent formulations—insulin glargine 300 U/mL and insulin degludec—offer an extended duration of action, flatter pharmacodynamic profiles and lower intrapatient variability. These advances enable more predictable glucose control, minimise nocturnal and severe hypoglycaemia, and allow flexible dosing schedules that can improve adherence. Basal insulin strategies now encompass individualised titration algorithms, integration with continuous glucose monitoring and combination with newer non-insulin agents. Globally, these approaches are instrumental in meeting stringent glycaemic targets, reducing microvascular complications and improving quality of life, while addressing the growing burden of both type 1 and type 2 diabetes.

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Basal Insulin Treatment Strategies in Diabetes Management publication trend

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Technical terms

Basal insulin: background insulin that maintains glucose homeostasis between meals and overnight.

Glycated haemoglobin (HbA1c): a measure of average blood glucose over two to three months.

Glycaemic variability: fluctuations in blood glucose levels over time.

Hypoglycaemia: abnormally low blood glucose concentration, often below 3.9 mmol/L.

Pharmacokinetics/pharmacodynamics: the study of a drug’s absorption, metabolism and effects on the body over time.

References

1. Efficacy and safety of insulin glargine 300 units/mL vs insulin degludec in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis. Frontiers in Endocrinology (2024).
2. Effect of switching from twice-daily basal insulin to once-daily insulin glargine 300 U/mL (Gla-300) in Brazilian people with type 1 diabetes. Diabetology & Metabolic Syndrome (2024).
3. Risk of hypoglycaemia with insulin degludec versus insulin glargine U300 in insulin-treated patients with type 2 diabetes: the randomised, head-to-head CONCLUDE trial. Diabetologia (2020).