Insulin intensification - the rationale and the target

P>Aims: To review the key evidence supporting targets for glycaemic control in people with type 2 diabetes and the implications for management in primary care. Method: Literature review. Results: Achieving early glycaemic control may reduce long-term risk by minimising the 'metabolic memory' effect of hyperglycaemia. Several large studies have failed to confirm expectations that intensive treatment would offer greater reductions in risk. This may reflect the failure to achieve control blood glucose early in the course of diabetes. Management guidelines emphasise the importance of targets for glycaemic control, but differ in the strategies they recommend for dose intensification. All, however, acknowledge the importance of individualising treatment. Conclusion: Early achievement of targets for glycaemic control may be important to reduce long-term risk in people with diabetes, but treatment should be tailored to individual need.