Insulin Therapy in People With Type 2 Diabetes: Opportunities and Challenges?

Abstract

Given the continued interest in defining the optimal management of individuals with type 2 diabetes, the Editor of Diabetes Care convened a working party of diabetes specialists to examine this topic in the context of insulin therapy. This was prompted by recent new evidence on the use of insulin in such people. The group was aware of evidence that the benefits of insulin therapy are still usually offered late, and thus the aim of the discussion was how to define the optimal timing and basis for decisions regarding insulin and to apply these concepts in practice. It was noted that recent evidence had built upon that of the previous decades, together confirming the benefits and safety of insulin therapy, albeit with concerns about the potential for hypoglycemia and gain in body weight. Insulin offers a unique ability to control hyperglycemia, being used from the time of diagnosis in some circumstances, when metabolic control is disturbed by medical illness, procedures, or therapy, as well as in the longer term in ambulatory care. For those previously starting insulin, various other forms of therapy can be added later, which offer complementary effects appropriate to individual needs. Here we review current evidence and circumstances in which insulin can be used, consider individualized choices of alternatives and combination regimens, and offer some guidance on personalized targets and tactics for glycemic control in type 2 diabetes.

Insulintherapie bei Typ-2-Diabetes mellitus

“…Die Mehrzahl der Patienten benötigt daher frü-her oder später eine Insulintherapie. Der Start einer Insulintherapie wird einer USamerikanischen Studie zufolge jedoch im Schnitt 5-10 Jahre verzögert [3,10]. Die Gründe dafür sind sehr unterschiedlich [17]: Patienten denken, dass Insulin nicht sehr wirksam sei oder sie betrachten es als persönliche Niederlage oder Zeichen einer fortgeschrittenen Erkrankung, wenn sie mit Insulin beginnen müssen.…”

Hemodialysis Associated with Severe and Unpredictable Hypoglycemia

“…It is well known that hypoglycemia is induced by various causes and that severe hypoglycemia may lead to lifethreatening hypoglycemic coma (1,2). Hypoglycemia is induced by the overuse of anti-diabetic drugs and/or insulin.…”

Instauration d’une insulinothérapie chez le patient diabétique de type 2 en médecine générale : Comparaison de l’étude belge InsuStar avec quelques études françaises et internationales

“…Pourtant, de nombreux essais cliniques ont montré les bénéfices d'une initiation précoce de l'insulinothérapie chez le patient avec un DT2 imparfaitement équilibré sous traitement oral [6]. Dans la vie réelle, l'insulinothérapie dans la prise en charge d'un patient DT2 représente certainement une opportunité, même si elle doit également faire face à des défis [7,8].…”