Given the progressive nature of type 2 diabetes (T2D), most individuals with the disease will ultimately undergo treatment intensification. This usually involves the stepwise addition of a new glucose-lowering agent or switching to a more complex insulin regimen. However, complex treatment regimens can result in an increased risk of hypoglycaemia and high treatment burden, which may impact negatively on both therapeutic adherence and overall quality of life. Individuals with good glycaemic control may also be overtreated with unnecessarily complex regimens. Treatment simplification aims to reduce individual treatment burden, without compromising therapeutic effectiveness or safety. Despite data showing that simplifying therapy can achieve good glycaemic control without negatively impacting on treatment efficacy or safety, it is not always implemented in clinical practice. Current clinical guidelines focus on treatment intensification, rather than simplification. Where simplification is recommended, clear guidance is lacking and mostly focused on treatment of the elderly. An expert, multidisciplinary panel evaluated the current treatment landscape with respect to guidance, published evidence, recommendations and approaches regarding simplification of complex insulin regimens. This article outlines the benefits of treatment simplification and provides practical recommendations on simplifying complex insulin treatment strategies in people with T2D using illustrative cases.

3rd Department of Internal Medicine 1st Faculty of Medicine Charles University Prague Czech Republic

CIBER Fisiopatología de la Obesidad y la Nutrición Instituto de Salud Carlos 3 Madrid Spain

Department of Endocrinology Medical University Sofia Sofia Bulgaria

Department of Medical Psychology Amsterdam University Medical Center Vrije Universiteit Amsterdam The Netherlands

Department of Metabolic Diseases Jagiellonian University Medical College Kraków Poland

Diabetes Research Centre University of Leicester Leicester UK

Division of Endocrinology and Metabolic Diseases University Hospital Università della Campania Luigi Vanvitelli Naples Italy

Instituto de Investigación Biomédica de Málaga University of Málaga Málaga Spain

Internal Medicine Department Regional University Hospital of Málaga Málaga Spain

Tameside and Glossop Integrated Care NHS Foundation Trust Ashton under Lyne UK

University of Manchester Manchester UK

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Expert Opinion on Optimising Type 2 Diabetes Treatment Using Fixed-Ratio Combination of Basal Insulin and GLP-1 RA for Treatment Intensification and Simplification

Expert Opinion on Current Trends in the Use of Insulin in the Management of People with Type 2 Diabetes from the South-Eastern European Region and Israel