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Empowering T2D management: The evolution of basal insulin therapy

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touchMDT Empowering T2D management: The evolution of basal insulin therapy

A multidisciplinary team and a patient advocate discuss best practices for insulin therapy in T2D

 Overview & Learning Objectives
Patient with T2D
  • Understanding clinical inertia in T2D: A multidisciplinary approach
    Endocrinologist, primary care specialist, and patient advocate
    Play Arrow Watch Video

    Watch and listen as an endocrinologist, a primary care specialist and a patient advocate discuss the reasons for delay in insulin therapy in T2D

    Time: 11:08
    Prof. Vilsbøll, Dr Zarifa, Mr Soroka
    Play Arrow Watch Video
  • Evolving options for insulin therapy: Fixed-ratio combinations and once-weekly regimens
    Endocrinologist and primary care specialist
    Play Arrow Watch Video

    Watch and listen as an endocrinologist and a primary care specialist review the latest data on once-weekly and other insulin formulations for T2D

    Time: 09:01
    Prof. Vilsbøll, Dr Zarifa
    Play Arrow Watch Video
  • Implementing continuous glucose monitoring in T2D: Why and how?
    Endocrinologist, primary care specialist, diabetes nurse educator and patient advocate
    Play Arrow Watch Video

    Hear insights on the strength and limitations of continuous glucose monitoring in T2D from an endocrinologist, a primary care specialist, a diabetes nurse educator and a patient advocate.

    Time: 12:22
    Prof. Vilsbøll, Dr Zarifa, Ms Berard, Mr Soroka
    Play Arrow Watch Video

Expert Spotlight

Prof. Tina Vilsbøll
Steno Diabetes Center University of Copenhagen, Denmark
Dr Gihane Zarifa
University of Toronto, Ontario, Canada
Mr Ostap Soroka
Toronto, Ontario, Canada

Prof. Tina Vilsbøll, Dr Gihane Zarifa and Mr Ostap Soroka explore reasons for delays in the initiation of insulin therapy in T2D.

Get the Audio Version

Tutorial

These icons indicate there is something to be interacted with. Click it when you see it.

Poll

The major reason patients with T2D may want to delay initiation of insulin therapy is

Submit your answer to see the results

Concerns about hypoglycaemia
   
Inconvenience of daily injections
   
Previous experience with family members
   
Fear of weight gain
   
Endocrinologist, primary care specialist, and patient advocate
Get the Audio Version
Understanding clinical inertia in T2D: A multidisciplinary approach
Time: 11:08
Prof. Vilsbøll, Dr Zarifa, Mr Soroka

Watch and listen as an endocrinologist, a primary care specialist and a patient advocate discuss the reasons for delay in insulin therapy in T2D

Watch Next
Endocrinologist and primary care specialist

Evolving options for insulin therapy: Fixed-ratio combinations and once-weekly regimens

Watch Now

Expert Spotlight

Prof. Tina Vilsbøll
Steno Diabetes Center University of Copenhagen, Denmark
Dr Gihane Zarifa
University of Toronto, Ontario, Canada

Prof. Tina Vilsbøll and Dr Gihane Zarifa discuss the rationale and data for once-weekly and other insulin formulations for T2D, and offer practical guidance.

Get the Audio Version

Tutorial

These icons indicate there is something to be interacted with. Click it when you see it.

Poll

What are key advantages to once-weekly insulin for patients with T2D who require insulin therapy?

Submit your answer to see the results

Efficacy is comparable to daily insulin
   
Safety is comparable to daily insulin
   
No need to monitor blood glucose levels
   
Fewer injections
   
Endocrinologist and primary care specialist
Get the Audio Version
Evolving options for insulin therapy: Fixed-ratio combinations and once-weekly regimens
Time: 09:01
Prof. Vilsbøll, Dr Zarifa

Watch and listen as an endocrinologist and a primary care specialist review the latest data on once-weekly and other insulin formulations for T2D

Watch Next
Endocrinologist, primary care specialist, diabetes nurse educator and patient advocate

Implementing continuous glucose monitoring in T2D: Why and how?

Watch Now

Expert Spotlight

Prof. Tina Vilsbøll
Steno Diabetes Center University of Copenhagen, Denmark
Dr Gihane Zarifa
University of Toronto, Ontario, Canada
Ms Lori Berard
Winnipeg, Canada
Mr Ostap Soroka
Toronto, Ontario, Canada

Prof. Tina Vilsbøll, Dr Gihane Zarifa, Ms Lori Berard and Mr Ostap Soroka discuss the role of continuous glucose monitoring for patients with T2D on insulin therapy.

Get the Audio Version

Tutorial

These icons indicate there is something to be interacted with. Click it when you see it.

Poll

What are key benefits to the use of continuous glucose monitoring for patients with T2D who are using insulin?

Submit your answer to see the results

Improved glycaemic control
   
Insight on glucose time-in-range
   
No finger sticks
   
Reduced risk of hypoglycaemia
   
Endocrinologist, primary care specialist, diabetes nurse educator and patient advocate
Get the Audio Version
Implementing continuous glucose monitoring in T2D: Why and how?
Time: 12:22
Prof. Vilsbøll, Dr Zarifa, Ms Berard, Mr Soroka

Hear insights on the strength and limitations of continuous glucose monitoring in T2D from an endocrinologist, a primary care specialist, a diabetes nurse educator and a patient advocate.

Watch Next
Endocrinologist, primary care specialist, and patient advocate

Understanding clinical inertia in T2D: A multidisciplinary approach

Watch Now
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Overview & Learning Objectives
Overview

In this touchMDT activity, a multidisciplinary team of experts in T2D and a patient advocate share their insights on best practices for basal insulin therapy in T2D. They explore reasons for delay of insulin therapy in T2D, the evolving options for insulin therapy, and why and how to implement continuous glucose monitoring in T2D.

This activity is provided by touchIME. touchIME is an EBAC® accredited provider.
read more

Target Audience

This activity has been designed to meet the educational needs of endocrinologists, diabetologists and primary care physicians involved in the management of patients with T2D.

Faculty

Prof. Tina Vilsbøll discloses:Advisory board or panel fees, consultant fees, speaker bureau fees, and/or grants/research support from Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Gilead, GSK, Mundipharma, Novo Nordisk, Roche/Carmot, Sanofi, Sun Pharmaceuticals and Zealand Pharma.

Dr Gihane Zarifa discloses: Employee or independent contractor relationship with Abbott, Diabetes Canada, GSK, Novo Nordisk and Peer Voice. Advisory board or panel fees from Embecta and Novo Nordisk. Consultant fees from Abbott, Diabetes Canada, GSK, Novo Nordisk and Peer Voice. Speaker Bureau fees from Diabetes Canada, GSK and Novo Nordisk.

Ms. Lori Berard discloses: Consultant fees from Abbott, Bayer, Diabetes care, Embecta, Montmed, Novo Nordisk and Roche. Speaker Bureau fees from Bayer, Dexcom, Eli Lilly and Embecta.

Mr Ostap Soroka has no interests/relationships or affiliations to disclose in relation to this activity.

Touch Medical Contributor

Annette Wiggins has no financial interests/relationships or affiliations in relation to this activity.

EBAC® Accreditation

touchIME is an EBAC® accredited provider since 2023.

This program is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for 48 minutes of effective education time. 

EBAC® holds an agreement on mutual recognition of substantive equivalency with the US Accreditation Council for CME (ACCME) and the Royal College of Physicians and Surgeons of Canada, respectively. 

Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) and the American Medical Association, physicians may convert EBAC® External CME credits to AMA PRA Category 1 Credits™. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other health care professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 Credit™. 

EBAC® is a member of the International Academy for CPD Accreditation (IACPDA) and a partner member of the International Association of Medical Regulatory Authorities (IAMRA).

Faculty Disclosure Statement / Conflict of Interest Policy

In compliance with EBAC® guidelines, all speakers/ chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CME activities.

Requirements for Successful Completion

Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed. 

Date of original release: 30 April 2025. Date credits expire: 30 April 2027.

Time to Complete: 48 minutes

If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org

Learning Objectives

After watching this activity, participants should be better able to:

  • Explain the current barriers to effective basal insulin therapy in patients with T2D and how these may be addressed by the multidisciplinary team
  • Describe the efficacy and safety of once-weekly insulin formulations and fixed-ratio combinations and the practical considerations for their effective use in patients with T2D
  • Evaluate the impact of CGM and time-in-range assessment in attaining glycaemic control in patients with T2D receiving basal insulin
Faculty & Disclosures
Prof. Tina Vilsbøll

Steno Diabetes Center University of Copenhagen, Denmark

Prof. Vilsbøll is the research leader of Cardio-Metabolic Prevention and consultant at Steno Diabetes Center Copenhagen, Denmark. She has been involved in clinical research since 1997, and in 2004 she established the Center for Diabetes Research at Gentofte Hospital, University of Copenhagen, Denmark. Her research is focused on the pathophysiology of obesity, prediabetes, type 2 diabetes, regulation of appetite and food intake, and the utilization of incretins as therapeutics. read more

Integration of the gut in the understanding of human glucose metabolism has become a major focus in her lab over recent years. Professor Vilsbøll is an experienced teacher and supervises several PhD and medical students conducting diabetes research. She has more than 470 scientific publications (H-index 89), several published books and book chapters. She is currently the Honorary Secretary and board member for the European Association for the Study of Diabetes (EASD) and is a frequently invited speaker at international meetings. In addition to her teaching and research posts, Professor Vilsbøll is a member of numerous professional societies and committees, and referees for several international journals.

Prof. Tina Vilsbøll discloses:Advisory board or panel fees, consultant fees, speaker bureau fees, and/or grants/research support from Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Gilead, GSK, Mundipharma, Novo Nordisk, Roche/Carmot, Sanofi, Sun Pharmaceuticals and Zealand Pharma.
Dr Gihane Zarifa

University of Toronto, Canada

Gihane (Gen) Zarifa is an assistant professor with the University of Toronto and a fellow with the College of Family Physicians of Canada. She received her Clinical Teacher Certificate in 2014. She completed her Bachelor of Science in microbiology and her Master of Science at the University of Toronto. She received her MD degree from the University of Toronto in 2000 and completed her training in family medicine in 2002. read more

She has been a staff physician at the Credit Valley Hospital, Department of Family Medicine, since 2002. She is a founding member of the University of Toronto Family Medicine Residency Programme at the Credit Valley Hospital in 2006.

She has had many contributions to curriculum development and has been an active educator for both residents and peers. She has served as the residency academic half-day coordinator from 2006 to 2021. She has also been the diabetes chronic disease management lead physician at the Credit Valley Family Health team since 2007 and has been an active contributor to many peer diabetes educational programmes.

Dr Gihane Zarifa discloses: Employee or independent contractor relationship with Abbott, Diabetes Canada, GSK, Novo Nordisk and Peer Voice. Advisory board or panel fees from Embecta and Novo Nordisk. Consultant fees from Abbott, Diabetes Canada, GSK, Novo Nordisk and Peer Voice. Speaker Bureau fees from Diabetes Canada, GSK and Novo Nordisk.
Ms Lori Berard

Winnipeg, Canada

Lori Berard has 37 years of experience in diabetes education, management and clinical research, working as the nurse manager for the Health Sciences Centre Diabetes Research Programme. She was also a faculty member at the University of Manitoba Department of Medicine Section of Endocrinology. Currently she is working as a consultant in diabetes management and clinical research operations. Lori has dedicated many years volunteering with Diabetes Canada and has extensive experience with the Clinical Practice Guidelines. She has been part of over 100 peer-reviewed publications and has received many honors and awards related to her work in diabetes.

Ms. Lori Berard discloses: Consultant fees from Abbott, Bayer, Diabetes care, Embecta, Montmed, Novo Nordisk and Roche. Speaker Bureau fees from Bayer, Dexcom, Eli Lilly and Embecta.
Mr Ostap Soroka

Toronto, Canada

Ostap Soroka has credentials in music, French and Italian literature, translation, editing, publishing, design, language and literacies education, TESL and project management. His first career was in performing arts. After a long transition through research, content writing, editing and translating, he is now teaching communication skills at the University of Toronto and Seneca Polytechnic.

Mr Ostap Soroka has no interests/relationships or affiliations to disclose in relation to this activity.
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This Activity Is Funded By:

An independent medical education grant from Novo Nordisk.

touchIME is an EBAC® accredited provider.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

EBAC® 

touchIME is an EBAC® accredited provider since 2023.

In compliance with EBAC® guidelines, all speakers/ chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CME activities.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME activities. touchIME accepts no responsibility for errors or omissions.

This content is intended for healthcare professionals outside of the UK and USA only.

Date of original release: 30 April 2025. Date credits expire: 30 April 2027.

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Question 1/5
According to results of a study of primary care clinicians in Canada, what was the average time from diagnosis of T2D to initiation of insulin?

T2D, type 2 diabetes.
 Correct

A study of primary care clinicians in Ontario looked at insulin initiation and intensification in patients with T2D. This study included 109 family physicians and 379 patients with T2D. On average, insulin initiation was delayed by 9.2 years, even in patients with T2D identified as being sufficiently high risk to warrant insulin therapy. 

Abbreviation

T2D, type 2 diabetes. 

Reference

Harris SB, et al. Can Fam Physician. 2010;56:e418–24.

Question 2/5
Your patient is a 60-year-old woman with T2D, diagnosed 5 years ago. She has been on semaglutide, metformin and empagliflozin for 12 months, but her HbA1c remains >8%. You discuss insulin initiation to achieve better glycaemic control, and the patient tells you that she is afraid of experiencing hypoglycaemia. How would you respond to this patient?

HbA1c, glycated haemoglobin; T2D, type 2 diabetes.
 Correct

Fear of hypoglycaemia is a key driver of therapeutic inertia for patients with T2D as well as clinicians. Patient-centered education that addresses hypoglycaemia concerns may help overcome inertia and ensure timely insulin intensification.1,2 Strategies such as continuous glucose monitoring may provide real-time reassurance about glucose levels.3 

Abbreviation

T2D, type 2 diabetes. 

References

  1. Gabbay RA, et al. Clin Diabetes. 2020;38:371–81.
  2. Gavin JR, et al. Diabetes Spectr. 2023;36:379–84.
  3. Edelman SV, et al. Diabetes Care. 2018;4:2265–74.
Question 3/5
Which of the following best describes the results for once-weekly insulin icodec compared with daily basal insulin in an insulin-naive population with T2D?

HbA1c, glycated haemoglobin; T2D, type 2 diabetes.
 Correct

ONWARDS 1 and ONWARDS 3 are clinical trials examining the effect of once-weekly insulin icodec versus once-daily insulin glargine and once-daily insulin degludec, respectively, in insulin-naive patients with T2D.1,2 The results demonstrated non-inferiority and superiority for icodec versus the comparator insulin for the mean change in HbA1c from baseline (ONWARDS 1: non-inferiority, p<0.001 and superiority, p=0.02;1 ONWARDS 3: non-inferiority, p<0.001 and superiority, p=0.0022). The rate of level 2 or 3 hypoglycaemia (per patient years of exposure) was 0.3 for icodec and 0.2 for the comparator daily insulin in both trials.1,2

Abbreviations

HbA1c, glycated haemoglobin; T2D, type 2 diabetes.

References

  1. Rosenstock J, et al. N Engl J Med. 2023;389:297–308.
  2. Lingvay I, et al. JAMA. 2023;330:228–37.
Question 4/5
Your patient with T2D is planning to use CGM to monitor his glucose levels after starting basal insulin therapy. Which of the following indicators would you advise him to focus on while he is adjusting to the device?

CGM, continuous glucose monitoring; T2D, type 2 diabetes.
 Correct

The use of real-time CGM is associated with several benefits for patients with T2D using insulin, including HbA1c reduction (0.6–1.6%) and fewer hypoglycaemic events.1,2 CGM technology greatly expands the ability to assess glycaemic control throughout the day, presenting critical data to inform daily treatment decisions and quantifying time below, within and above the established glycaemic targets. Time-in-range, defined as the percentage of time when CGM readings are between 3.9–10.0 mmol/L (70–180 mg/dL), is a key indicator of glycaemic control. According to recommendations from an international consensus on CGM,3 patients with T2D should aim for a time-in-range >70% or >16 hours and 48 minutes in a day. 

Abbreviations

CGM, continuous glucose monitoring; T2D type 2 diabetes.

References

  1. Karter AJ, et al. JAMA. 2021;325:2273–84.
  2. Jackson MA, et al. Diabetes Technol Ther. 2021;23:S27–34. 
  3. Battelino T, et al. Diabetes Care. 2019;42:1593–603.
Question 5/5
Your patient is a 55-year-old man with T2D. He started basal insulin 6 months ago and is frustrated with having to check his glucose levels throughout the day. You suggest that he try using CGM, but he expresses concern about skin irritation and being able to use the device. What do you recommend to help him monitor his glucose levels?

CGM, continuous glucose monitoring; T2D type 2 diabetes.
 Correct

The need for glucose monitoring significantly influences patients’ acceptance of insulin therapy in T2D, primarily through its impact on perceived burden, empowerment and clinical outcomes. CGM provides real-time feedback on how diet, exercise and insulin doses affect glucose levels.1 A multimodal approach to addressing practical concerns about CGM, which combines education and technical support, may help empower patients and optimize device utility.2,3 A trial period supported by education may help patients adjust to the device and manage any concerns. 

Abbreviations

CGM, continuous glucose monitoring; T2D, type 2 diabetes.

References

  1. Kinson L, Inman K. Clin Diabetes. 2025;43:139–47.
  2. Zheng M, et al. BMJ Open. 2021;11:e046050. 
  3. Arbiter B, et al. Diabetes Spectr. 2019;32:221–5.
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