Achieving target glycaemic control is essential in people with diabetes to minimize the risk of long-term complications, and many people with type 2 diabetes will ultimately require basal insulin (BI) therapy to achieve their individualized glycaemic targets. Usually, the first 12 weeks following initiation of BI therapy represents the period when the greatest dose increases and glycaemic reductions occur. Effective glycaemic control combined with minimizing the risk of hypoglycaemia is important to enable the achievement of glycaemic control in the longer term. However, substantial therapeutic inertia exists in clinical practice, both in initiation and up-titration of BI, owing to patient-, physician- and healthcare system-related barriers, including fear of hypoglycaemia and the perception of a burdensome regimen. The more prolonged duration of action, reduced glycaemic variability and lower risk of hypoglycaemia seen with second-generation versus first-generation BI analogues may help alleviate patients' and physicians' concerns and facilitate titration. In turn, optimal BI titration and subsequent metabolic benefits may help improve therapy adherence and self-management. This review details the clinical implications of prompt titration of BI to achieve early glycaemic control, and the importance of minimizing hypoglycaemia risk within the initial titration period. Facilitation of patients' self-management of BI is also addressed.

中文翻译：

---

基础胰岛素滴定初始阶段对糖尿病患者的重要性。

对于糖尿病患者来说，实现目标血糖控制对于最大限度地降低长期并发症的风险至关重要，许多 2 型糖尿病患者最终将需要基础胰岛素 (BI) 治疗来实现其个体化血糖目标。通常，开始 BI 治疗后的前 12 周是最大剂量增加和血糖降低的时期。有效的血糖控制与最大限度地降低低血糖风险相结合对于实现长期血糖控制非常重要。然而，由于患者、医生和医疗保健系统相关的障碍，包括对低血糖的恐惧和对繁琐的治疗方案的看法，在临床实践中，无论是开始还是增加 BI，都存在很大的治疗惰性。与第一代 BI 类似物相比，第二代 BI 类似物的作用持续时间更长、血糖变异性更小、低血糖风险更低，可能有助于减轻患者和医生的担忧并促进滴定。反过来，最佳的 BI 滴定和随后的代谢益处可能有助于提高治疗依从性和自我管理。本综述详细介绍了及时滴定 BI 以实现早期血糖控制的临床意义，以及在初始滴定期内最大限度降低低血糖风险的重要性。还讨论了促进患者自我管理 BI 的问题。