Improving postprandial hyperglycemia in patients with type 2 diabetes already on basal insulin therapy: R eview of current strategies

A large number of patients with type 2 diabetes ( T 2 D ) on basal insulin do not reach their H b A 1c goals and require additional therapy to address postprandial hyperglycemia. Guidelines from expert bodies have outlined several approaches to accomplish postprandial glucose ( PPG ) control, and recent literature suggests several more. This article provides strategies for primary care physicians caring for patients with T 2 D who do not achieve glycemic control with basal insulin alone. Current treatment guidelines and strategies for improving PPG control are reviewed, including the efficacy, safety, and cost‐effectiveness of rapid‐acting insulin ( RAI ) analogs, premixed insulin, glucagon‐like peptide‐1 ( GLP ‐1) receptor agonists ( RA s), dipeptidyl peptidase 4 inhibitors, sodium–glucose cotransporter 2 inhibitors, and α‐glucosidase inhibitors. Other approaches, such as combinations of newer basal insulin plus RAI and a fixed‐ratio combination of basal insulin and a GLP‐1 RA, are also described.