Using insulin earlier in the treatment of type 2 diabetes

Abstract

Type 2 diabetes is a progressive disease. Initial management with diet and exercise is fundamental. However, even if concordance is good, many will go on to require oral agent therapy to control hyperglycaemia. Initial metformin monotherapy and then oral combination therapy may be required as the disease progresses. When combinations of oral agents are insufficient to achieve good glycaemic control insulin therapy will be required. Various combinations of insulin and oral agents can be used to reduce the complications of hypoglycaemia and weight gain associated with insulin treatment. Simple regimes, using once-daily long-acting insulin analogues combined with oral metformin would seem to offer the possibility of good glycaemic control with minimal weight gain and hypoglycaemia.