9
Recommendation 8
➤ ES suggests that rapid-acting insulin analogs be used rather than
regular (short-acting) human insulins for adult and pediatric patients
on basal-bolus insulin therapy who are at high risk for hypoglycemia.
(2|⊕
)
Remarks:
▶ Patients who are at high risk for hypoglycemia are defined as those with a history
of severe hypoglycemia (requiring assistance to manage), IAH, and/or medical
conditions that predispose them to severe hypoglycemia including renal and hepatic
dysfunction.
▶ The panel placed high value on reducing severe hypoglycemia and found moderate-
certainty evidence for reduction of mild-to-moderate and severe hypoglycemia as an
outcome in those using rapid-acting analog insulins versus regular (short-acting )
insulin. However, the panel acknowledges that many studies were designed to
demonstrate non-inferiority of analog insulin compared with human regular (short-
acting ) insulin. Also, much of the data available for review demonstrating reductions
in hypoglycemia was in adults with T1D; very little data were available regarding
the pediatric population.
Recommendation 9
➤ ES recommends that a structured program of patient education over
unstructured advice be used for adult and pediatric outpatients with
T1D or T2D receiving insulin therapy. (1|⊕⊕
)
Remarks:
▶ Structured education on how to avoid repeated hypoglycemia is critical, and this
education should be performed by experienced diabetes clinicians. Moreover, insurance
coverage for education should be available for all insulin-using patients.
▶ The recommendation is not intended to limit structured education only to those on
insulin therapy; for example, patients using sulfonylureas and meglitinides are also at
risk for hypoglycemia, and the recommendation also applies to this patient population.
