Core IM | Internal Medicine Podcast #200: Insulin and QWINT-1 Trial in T2DM: Beyond Journal Club Segment with NEJM Group
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Feb 11, 2026 Lakshmira Vindra, endocrinologist and NEJM editorial fellow, outlines diabetes physiology and trial evidence with clarity. She walks through insulin types and when to start therapy. The conversation explains the QWINT-1 trial comparing once-weekly insulin to daily glargine. They discuss hypoglycemia differences, practical patient phenotypes, and oral alternatives to minimize injections.
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Remember Insulin Classes And Durations
- Insulins vary by pharmacokinetics: rapid, short, intermediate, and long acting guide use.
- Mnemonics (LOG for rapid, perfect squares for durations) help clinicians remember timing and dosing.
When To Consider Starting Insulin
- Consider insulin when patients have hyperglycemia symptoms or very high glucose (A1c >10% or glucose >300 mg/dL).
- Weigh the life-changing burden of injections and monitoring before initiating insulin.
Dementia Patient Struggled With Insulin
- Shreya described an older patient with early dementia who struggled with a complex insulin regimen living alone.
- Her A1c rose from 7% to 9.8% after difficulties with self-administration.