Insulin Analogs or Premixed Insulin Analogs in Combination With Oral Agents for Treatment of Type 2 Diabetes

Philip Levy, MD, FACE


April 16, 2007


Type 2 diabetes is a progressive disease. At the time of diagnosis, patients should be informed that insulin therapy is part of the natural course of diabetes, and not a last resort to be feared or avoided. Although initial treatment may begin with oral agents, the vast majority will transition to insulin therapy to achieve and maintain good glycemic control. Insulin therapy has become more flexible and convenient with insulin analogs (which more closely mimic physiologic insulin secretion than human insulins) and better insulin delivery systems. Addition of once- or twice-daily administration of long-acting insulin analogs to OADs effectively lowers A1C in patients with an elevated FPG, and with less risk for hypoglycemia compared with NPH. Mealtime administration of rapid-acting insulin analogs decreases postprandial glucose excursions and lowers A1C. Premixed insulin analogs provide an effective and convenient approach to controlling FPG and PPG and lowering A1C levels in patients with type 2 diabetes transitioning to insulin therapy. The reduction in regimen complexity achieved with premixed insulin analogs has the potential to overcome an important barrier to successful insulin therapy. Compared to conventional insulins, the insulin analogs also decrease the risk for hypoglycemia, which can prevent patients from adhering to insulin-based regimens. Selection of appropriate insulin analogs and convenient injection devices can facilitate the transition to insulin therapy. Patient education about insulin, its potential benefits, and how to manage symptoms of hypoglycemia are also important for decreasing patient anxiety and optimizing adherence. Ultimately, a physician's choice of insulin therapy should be individualized according to the patient's glycemic parameters, treatment preferences, and lifestyle.


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