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Southern Medical Journal:
Review Article

Strategies for Insulin Therapy in Type 2 Diabetes

Edelman, Steven V. MD; Morello, Candis M. PHARMD, CDE

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Abstract

Chronic hyperglycemia in type 2 diabetes is responsible for an array of microvascular and macrovascular complications that can lead to significant morbidity and mortality. Several well-conducted large clinical studies have shown that normalizing blood glucose levels can help prevent the onset and slow the progression of complications from diabetes. As many as 25% of patients treated with oral hypoglycemic agents require the addition of insulin therapy to compensate for the progression of β-cell failure and an inability to maintain glycemic control. Various strategies incorporating the use of insulin early in the course of the disease have been developed to meet this goal, and include the use of basal-bolus insulin regimens as well as bedtime insulin injections. The pharmacokinetic properties of the new insulin analogs (eg, insulin lispro, insulin aspart, insulin glargine) offer significant advantages, such as improved control of nocturnal hypoglycemia with basal insulin glargine, and improved postprandial glucose control, with insulin lispro or insulin aspart.

Key Points

* Clinical studies reveal that normalizing blood glucose and mimicking normal insulin secretion in patients with type 2 diabetes may prevent the onset and delay the progression of diabetic complications.

* Traditional regimens have failed to maintain glycemic control because of the progressive decline of β-cell function, resulting in patients requiring insulin therapy.

* Strategies have been developed to provide exogenous insulin.

© 2005 Southern Medical Association

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