[Comment] Beyond insulin escalation: REIMAGINE 3 and advanced type 2 diabetes care

Beyond insulin escalation: REIMAGINE 3 and advanced type 2 diabetes care Affiliations & Notes aDiabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, Amsterdam 1105 AZ, Netherlands bDepartment of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands Article Info Publication History: Published June 7, 2026 DOI: 10.1016/S0140-6736(26)01074-3 External LinkAlso available on ScienceDirect External Link Copyright: © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies. Download started OkA large proportion of people living with type 2 diabetes treated with basal insulin therapy remain inadequately controlled despite progressive treatment intensification,1 leaving many susceptible to microvascular and macrovascular complications.2 Treatment intensification has traditionally focused on complex insulin regimens, with hypoglycaemia and weight gain as undesirable adverse effects. Thus, the need for therapies that improve glycaemic control in people inadequately controlled on basal insulin therapy remains pressing. References 1. Dalal, MR ∙ Grabner, M ∙ Bonine, N ∙ et al. Are patients on basal insulin attaining glycemic targets? Characteristics and goal achievement of patients with type 2 diabetes mellitus treated with basal insulin and physician-perceived barriers to achieving glycemic targets Diabetes Res Clin Pract. 2016; 121:17-26 2. Stratton, IM ∙ Adler, AI ∙ Neil, HA ∙ et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study BMJ. 2000; 321:405-412 3. Billings, LK ∙ Doshi, A ∙ Gouet, D ∙ et al. Efficacy and safety of IDegLira versus basal-bolus insulin therapy in patients with type 2 diabetes uncontrolled on metformin and basal insulin: the DUAL VII randomized clinical trial Diabetes Care. 2018; 41:1009-1016 4. Rosenstock, J ∙ Frías, JP ∙ Rodbard, HW ∙ et al. Tirzepatide vs insulin lispro added to basal insulin in type 2 diabetes: the SURPASS-6 randomized clinical trial JAMA. 2023; 330:1631-1640 5. Badve, SV ∙ Bilal, A ∙ Lee, MMY ∙ et al. Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: a meta-analysis of randomised controlled trials Lancet Diabetes Endocrinol. 2025; 13:15-28 6. Muskiet, MHA ∙ Smits, MM Beyond a singular focus on GLP-1: why we need a new nomenclature now Lancet Diabetes Endocrinol. 2025; 13:730-733 7. Drucker, DJ GLP-1-based therapies for diabetes, obesity and beyond Nat Rev Drug Discov. 2025; 24:631-650 8. Muskiet, MHA ∙ Nardone, M ∙ Rensen, PCN ∙ et al. Amylin and the renin-angiotensin system: risk or opportunity in amylin-based therapy? Lancet. 2026; 406:2980-2983 9. Walker, CS ∙ Aitken, JF ∙ Vazhoor Amarsingh, G ∙ et al. Amylin: emergent therapeutic opportunities in overweight, obesity and diabetes mellitus Nat Rev Endocrinol. 2025; 21:482-494 10. Rosenstock, J ∙ Billings, LK ∙ Gajria, R ∙ et al. Cagrilintide–semaglutide (CagriSema) as an add-on to basal insulin in adults with type 2 diabetes (REIMAGINE 3): a randomised, double-blind, placebo-controlled, multicentre, phase 3 study Lancet. 2026; published online June 7. https://doi.org/10.1016/S0140-6736(26)01022-6 11. American Diabetes Association Professional Practice Committee for Diabetes 9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes—2026 Diabetes Care. 2026; 49(suppl 1):S183-S215 12. Lingvay, I ∙ Bergenheim, SJ ∙ Buse, JB ∙ et al. Once-weekly semaglutide 7·2 mg in adults with obesity and type 2 diabetes (STEP UP T2D): a randomised, controlled, phase 3b trial Lancet Diabetes Endocrinol. 2025; 13:935-948