Evidence map›Paper›PMID 41984372›Full record

ReviewDiabetes therapy : research, treatment and education of diabetes and related disorders2026

Optimizing Type 2 Diabetes Management in Iraq: Expert Consensus on Initiation and Intensification of Insulin-Based Treatment Options.

Charles Saab, Abbas Ali Mansour, Abbas Mahdi Rahmah, Delman Raoof Al-Attar, Haidar Fadhil Al-Rubay'e, Haider Ayad Alidrisi, Hussein Ali Nwayyir, Mahmood Shakir Khudhair, Mazyar Jabbar Ahmed, Salim Marzouq Al-Ibrahimi and 1 more

Abstract readReview
In one paragraph

Review in Diabetes therapy : research, treatment and education of diabetes and related disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Charles SaabClinical Research Programs-Sacré-Coeur University Hospital, Beirut, Lebanon. drcsaab@hotmail.com.ORCID http://orcid.org/0000-0003-4233-8088
Abbas Ali MansourFaiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), University of Basrah, Basrah, 61013, Iraq.ORCID http://orcid.org/0000-0001-8083-6024
Abbas Mahdi RahmahInternal Medicine National Diabetes Center, Mustansiriya University, Baghdad, Iraq.ORCID http://orcid.org/0000-0003-0368-4383
Delman Raoof Al-AttarInternal Medicine and Endocrinology Branches, Faruk Medical City, Kurdistan, Iraq.ORCID http://orcid.org/0009-0004-7058-1573
Haidar Fadhil Al-Rubay'eInternal Medicine & Endocrinology, College of Medicine, Department of Medicine, Mustansiriya, Baghdad, Iraq.ORCID http://orcid.org/0000-0002-3912-8103
Haider Ayad AlidrisiMedicine and Endocrinology, College of Medicine of the General Endocrine Unit, Faiha Specialized Diabetes, Endocrine and Metabolism Center, University of Basrah, Baghdad, Iraq.ORCID http://orcid.org/0000-0003-3132-1758
Hussein Ali NwayyirFaiha Diabetes, Endocrine and Metabolism Center, Department of Medicine, College of Medicine, University of Basra, Baghdad, Iraq.ORCID http://orcid.org/0000-0001-7926-3660
Mahmood Shakir KhudhairScientific Committee for the Study of Diabetes and Endocrinology at the Iraqi Board of Medical Specialties, Baghdad, Iraq.ORCID http://orcid.org/0000-0001-8183-6683
Mazyar Jabbar AhmedKHCMS Endocrinology Program of Kurdistan Diabetes Association (KDA), Sulaymaniyah, Iraq.ORCID http://orcid.org/0009-0009-0340-2519
Salim Marzouq Al-IbrahimiAl-Manathira Hospital, Al-Najaf, Iraq.ORCID http://orcid.org/0009-0001-1397-0204
Taha Othman MahwiInternal Medicine of Sulaimanyah Diabetes Center, Kurdistan Board for Medical Specialization, Kurdistan Diabetes Association (KDA), Erbil, Iraq.ORCID http://orcid.org/0000-0001-9477-8814

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionType 2 diabetes mellitus (T2DM) prevalence in Iraq is projected to rise significantly by 2045, creating urgent need for optimized use of latest insulin therapies. An expert panel of eleven diabetes specialists convened to assess the evolving landscape of insulin therapies and explore how each option fits into current strategies to optimize T2DM management in Iraq.

methodsThe panel reviewed international guidelines and local practice patterns through pre-meeting surveys. Discussions focused on initiation and intensification of insulin-based treatment in Iraq's context, considering accessibility challenges and patient characteristics.

resultsWhen hemoglobin A1c (HbA1c) is < 2% above target, basal insulin (BI) is recommended for patients with body mass index (BMI) ≤ 30. For BMI > 30, either GLP-1 receptor agonist (GLP-1 RA) monotherapy or a fixed ratio combination (FRC) of GLP-1 RA and BI is preferred. When HbA1c is ≥ 2% above target, initiation with BI and GLP-1 RA is advised across BMI groups. If glycemic targets are not achieved despite reaching 0.5 U/kg of BI, prandial insulin may be added via premixed regimen or basal-bolus regimens based on individual factors. Premix insulin remains an alternative when other options are unavailable. Key barriers in Iraq include high cost and limited availability of GLP-1 RAs, therapeutic inertia, and gaps in healthcare infrastructure. Final treatment decisions should consider disease severity, cardiovascular and renal comorbidities, and weight goals.

conclusionThe panel curated clinical practical recommendations about injectable insulin therapies and proposed a structured treatment algorithm tailored to Iraq's healthcare setting, prioritizing simplicity, efficacy, tolerability and accessibility. The panel emphasized the critical role of second-generation BIs and FRCs of BI and GLP-1 RA in Iraq's T2DM treatment algorithm, providing clear guidance on their optimal use and place in therapy, overcoming barriers, alongside enhanced education for healthcare providers and patients.

Indexed as

Basal InsulinFixed-ratio combinationsGLP-1 Receptor AgonistsInsulin TherapiesIraq Healthcare ChallengesType 2 Diabetes Mellitus

Identifiers

PMID41984372
PMCPMC13156370

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.