title: Insulin therapy in people with type 2 diabetes: opportunities and challenges?
abstract: Given the continued interest in defining the optimal management of individuals with type 2 diabetes, the Editor of Diabetes Care convened a working party of diabetes specialists to examine this topic in the context of insulin therapy. This was prompted by recent new evidence on the use of insulin in such people. The group was aware of evidence that the benefits of insulin therapy are still usually offered late, and thus the aim of the discussion was how to define the optimal timing and basis for decisions regarding insulin and to apply these concepts in practice. It was noted that recent evidence had built upon that of the previous decades, together confirming the benefits and safety of insulin therapy, albeit with concerns about the potential for hypoglycemia and gain in body weight. Insulin offers a unique ability to control hyperglycemia, being used from the time of diagnosis in some circumstances, when metabolic control is disturbed by medical illness, procedures, or therapy, as well as in the longer term in ambulatory care. For those previously starting insulin, various other forms of therapy can be added later, which offer complementary effects appropriate to individual needs. Here we review current evidence and circumstances in which insulin can be used, consider individualized choices of alternatives and combination regimens, and offer some guidance on personalized targets and tactics for glycemic control in type 2 diabetes.
authors.affiliation: Newcastle University, Newcastle upon Tyne, U.K.
authors.forename: Philip
authors.initials: P
authors.lastname: Home
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Matthew
authors.initials: M
authors.lastname: Riddle
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA william.cefalu@pbrc.edu.
authors.forename: William T
authors.initials: WT
authors.lastname: Cefalu
authors.affiliation: FRCPath, Aston University, Birmingham, U.K.
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Bailey
authors.affiliation: Justus Liebeg University, Giessen, Germany.
authors.forename: Reinhard G
authors.initials: RG
authors.lastname: Bretzel
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Prato
authors.affiliation: Mount Sinai Medical School, New York, NYRambam Technion Hospital, Haifa, Israel.
authors.forename: Derek
authors.initials: D
authors.lastname: Leroith
authors.affiliation: Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: Guntram
authors.initials: G
authors.lastname: Schernthaner
authors.affiliation: Antwerp University Hospital, Antwerp, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: van Gaal
authors.affiliation: Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Raz
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin