Issue 131 Item 11 Initial Treatment with Insulin for Type 2’s Provide Better Out

Starting treatment with insulin early in the course of type 2 diabetes may improve metabolic control. Type 2 diabetes is a progressive disease and metabolic control is usually maintained in steps: when diet and exercise modifications fail, treatment with oral hypoglycemic drugs begins. When these drugs fail, treatment with insulin begins. Starting treatment with insulin or insulin analogues before oral hypoglycemic drugs fail may further improve glycemic control, provide a ‘bridge’ from oral-only to insulin-only therapy, and improve the well-being of patients.

Preliminary evidence suggests that novel formulations of biphasic insulin analogues may be effective in combination with oral hypoglycemic drugs. In premixed and dual-release formulations of insulin analogues, insulin is released in two phases: one portion is absorbed slowly while the fast-acting component is absorbed more rapidly than conventional soluble insulin. These formulations can be injected 15 minutes or less before a meal and effectively limit postprandial glucose excursions compared with conventional biphasic insulin, which is injected 30 minutes before a meal. The author suggests that starting treatment with insulin early in the course of type 2 diabetes may improve metabolic control, and that insulin analogues twice daily in combination with oral hypoglycemic drugs may offer a convenient and effective treatment option.

International Journal of Obesity 2002;26:S25-S30