Can glycemic targets be achieved-- in particular with two daily injections of a mix of intermediate- and short-acting insulin?
OBJECTIVE
To present data that demonstrate the feasibility of using twice-daily insulin injections, in combination with selected orally administered agents, to achieve glycemic targets in patients with type 2 diabetes.


METHODS
Recent studies of the effects of various therapeutic strategies in patients with type 2 diabetes are reviewed, and the rationale for and recommended approaches in the use of combination treatment to achieve glycemic goals are discussed.


RESULTS
The combination of insulin and insulin sensitizers is an effective option for achieving glycemic goals (hemoglobin A1c pound 6.5%). Although thiazolidinediones are better sensitizers than metformin, they are associated with significant weight gain. In contradistinction, metformin, an effective insulin sensitizer, causes less weight gain. The sequence in which these two sensitizers are added to insulin therapy is important; if metformin is added before a thiazolidinedione, weight gain may be avoided.


CONCLUSIONS
Glycemic targets can be achieved with use of twice-daily mixtures of intermediate- and short-acting insulin in a high percentage of patients with type 2 diabetes.
Raskin
Philip
P
University of Texas Southwestern Medical Center, Dallas, USA.
D002839:Chromans / Q000008:administration & dosage; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008687:Metformin / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D045162:Thiazolidinediones / Q000008:administration & dosage; D000077288:Troglitazone
D002839:Chromans; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008687:Metformin; D045162:Thiazolidinediones; D000077288:Troglitazone