Insulin therapy in type 2 diabetes

Type 2 diabetes is a common disorder often accompanied by numerous metabolic abnormalities leading to high risk of cardiovascular morbidity and mortality. Results from the UK Prospective Diabetes Study have confirmed that intensive glucose control delays the onset and retards the progression of microvascular disease, possibly in those with type 2 diabetes. In the early stages of the disease, insulin resistance plays a major role in the development of hyperglycemia and other metabolic abnormalities, and patients with type 2 diabetes often benefit from measures to improve insulin sensitivity such as weight loss, dietary changes, and exercise. Later, the use of oral insulin secretagogues and insulin sensitizers as monotherapy and in combination helps maintain glycemia for varying periods of time. Ultimately, because of the progressive nature of the disease and the progressive decline in pancreatic beta cell function, insulin therapy almost always is obligatory to achieve optimal glycemic goals.