Update on insulin therapy for type 2 diabetes

Thomas W Donner, Miguel Muñoz

Research output: Contribution to journalArticle

Abstract

Type 2 diabetes is characterized by insulin resistance and impaired insulin secretion at diagnosis and by progressive β-cell dysfunction overtime. Insulin therapy is thus frequently required during the course of the disease to maintain glycemic control and prevent diabetes complications. Insulin should be initiated when alternative antihyperglycemic agents have failed or when symptomatic or marked hyperglycemia is present. Recent studies demonstrate that the addition of basal, prandial, basal/bolus, or premixed insulins to existing antihyperglycemic regimens effectively lowers glycosylated hemoglobin (HbA 1c). The long-acting insulin analogs cause less nocturnal hypoglycemia than bedtime NPH, with comparable HbA1c reductions. Insulin detemir confers a weight advantage over glargine or NPH. Rapid-acting insulin analogs control postprandial hyperglycemia more effectively than regular insulin and modestly lower HbA1c. For selected patients with severe insulin resistance, U-500 is a less expensive and potentially more effective alternative to U-100 insulin. Adverse effects of insulin, including weight gain and hypoglycemia, can be minimized by initial use of basal insulins in combination with metformin, incretin mimetics, or dipeptidylpeptidase-IV inhibitors. Although in vitro studies suggest that hyperinsulinemia may promote tumorigenesis, no currently available insulin has been shown to increase cancer rates. Targeting near-normal glucose levels in insulin-treated patients should be reserved for those of younger age with a longer life expectancy, a shorter duration of diabetes, and little or no end-organ complications. A higher HbA1c target of 7-8% is more appropriate for patients less likely to benefit from intensive control and in those at high risk for severe hypoglycemia.

Original languageEnglish (US)
Pages (from-to)1405-1413
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number5
DOIs
StatePublished - May 2012

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Medical problems
Type 2 Diabetes Mellitus
Insulin
Hypoglycemia
Insulins
Therapeutics
Hypoglycemic Agents
Hyperglycemia
Insulin Resistance
Long-Acting Insulin
Short-Acting Insulin
Incretins
Metformin
Glycosylated Hemoglobin A
Hyperinsulinism
Diabetes Complications
Life Expectancy
Weight Gain
Meals
Carcinogenesis

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Update on insulin therapy for type 2 diabetes. / Donner, Thomas W; Muñoz, Miguel.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 97, No. 5, 05.2012, p. 1405-1413.

Research output: Contribution to journalArticle

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