Insulinothérapie basale: pourquoi des objectifs glycémiques ambitieux?

Insulin therapy is associated with complicated diabetes; this association is a consequence of the frequent use of insulin in late stages of the disease, when no other option is available or efficacious. However, it may prevent insulin to be used early with the aim of postponing the development of complications. The time spent in hyperglycemia determines the risk of complications, but also directly influences the duration of the very good control required to have a benefit. Early insulin therapy is an option to consider not to lose time during the therapeutic escalation, as it combines efficacy and durability, avoiding iterative periods of exposure to hyperglycemia. But alone basal insulin is insufficient, and it has side effects: weight gain and hypoglycemia; these hypoglycemia are less frequent with long-acting insulin analogs, and even less with the new insulin formulations.