Up to 40% of people with type 2 diabetes ultimately require insulin therapy, yet only about one-third start basal insulin—leaving many patients hyperglycemic longer than they should be. In the PeerView Institute educational activity Betting on Basal Insulin: Improving the Odds for People With Type 2 Diabetes, experts from ATTD 2026 emphasized earlier identification, smarter initiation, and practical titration of basal insulin to improve outcomes.

Why It Matters To Your Practice

• NPs and PAs are often the clinicians who spot persistent hyperglycemia first, recognize when oral or noninsulin therapy is no longer enough, and move care forward before complications mount.

• Therapeutic inertia is common in Diabetes mellitus (DM), and your frontline judgment can be the difference between “watchful waiting” and timely intensification.

• When patients trust you with day-to-day barriers—cost, fear of injections, confusion about titration—you are uniquely positioned to turn hesitation into action.

Clinical Benefits

• Basal insulin can address ongoing fasting hyperglycemia in patients whose A1C remains above target despite current therapy.

• Earlier, individualized initiation and titration may simplify care, improve adherence, and reduce prolonged exposure to uncontrolled glucose.

• Emerging insulin and combination options may help tailor regimens for patients with complex needs, adherence challenges, or treatment resistance.

Managing Risks

• Start with patient selection: identify who is most likely to benefit from basal insulin and who may need a more customized transition plan.

• Counsel clearly on titration, injection technique, monitoring, and hypoglycemia prevention so patients know exactly what the next step looks like.

• Address common barriers early, including fear of weight gain, regimen burden, and persistence challenges that can undermine success.

The Bottom Line

• You are not “backup” to the physician in this decision—you are often the clinician who makes intensification happen safely, confidently, and on time.

• For patients with T2D who remain hyperglycemic, basal insulin is still a key tool, and NPs and PAs can lead its initiation, titration, and follow-through.

• When you act decisively against therapeutic inertia, patients do more than start insulin—they get a real chance at better control.