Up to 40% of people with type 2 diabetes (T2D) ultimately require insulin therapy—yet only about one-third start basal insulin, leaving many with persistent hyperglycemia due to therapeutic inertia and adherence barriers. A PeerView Institute for Medical Education enduring activity (based on a live panel at ATTD 2026, “Betting on Basal Insulin: Improving the Odds for People With Type 2 Diabetes”) focuses on practical initiation, titration, and regimen-simplification strategies to close that gap.

Why It Matters To Your Practice

• Delayed basal insulin initiation is common and can prolong time spent above individualized glycemic targets, increasing symptom burden and complication risk.

• NPs and PAs are often the continuity clinicians who can identify “persistent hyperglycemia” patterns early and operationalize stepwise intensification.

• Clear, repeatable workflows (who qualifies, when to start, how to titrate, when to transition) reduce therapeutic inertia in busy clinics.

Clinical Benefits

• Earlier basal insulin for appropriate candidates can improve fasting glucose control and help patients reach A1c goals when non-insulin regimens are no longer sufficient.

• Structured titration plans can make outcomes more predictable and reduce “stuck on the starting dose” scenarios.

• Personalized plans that address barriers (fear of injections, complexity, cost, monitoring burden) can improve adherence and persistence.

Managing Risks

• Hypoglycemia risk: start conservatively, titrate methodically, and reassess concomitant agents that increase hypoglycemia risk; educate on recognition and treatment.

• Weight gain and patient acceptance: set expectations, reinforce nutrition/activity counseling, and consider regimen choices that may simplify care and support persistence.

• Safety and follow-up: use scheduled check-ins (in-person, telehealth, portal) and documented titration instructions to avoid under- or over-titration.

The Bottom Line

• If hyperglycemia persists despite optimized non-insulin therapy, don’t wait: identify candidates and initiate basal insulin with a clear titration pathway.

• Standardize your clinic’s insulin-start workflow to reduce therapeutic inertia and improve follow-through.

• Pair insulin initiation with barrier-focused counseling and proactive follow-up to support durable control in Diabetes mellitus (DM).