The need to improve glycaemic control in type 2 diabetes has been reinforced by the United Kingdom Prospective Diabetes Study (UKPDS). Due to progressive deterioration of beta-cell function after diagnosis, oral hypoglycaemic agents often fail to maintain adequate glycaemic control after only a few years of treatment. This paper considers the treatment options available at this stage and reassures diabetologists that the combined use of insulin plus metformin with or without an added sulphonylurea is logical, is as effective as insulin alone, and provides superior weight regulation in many patients. A. combination of metformin with glargine insulin seems particularly effective and well tolerated. The long-term advantages of such treatments in terms of clinical outcomes have yet to be demonstrated in clinical trials.
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