The use of insulin in type 2 diabetes

Oral agents have traditionally been the first line pharmacological therapy for type 2 diabetes. However, it is known from the UKPDS trial that these agents fail to control glycaemia over the long term and overall about 6% of patients need to be transferred onto insulin therapy every year. In addition insulin has been tested as a first line therapy in the UKPDS trial and found to be equally efficacious as sulphonylureas in controlling glycaemia and preventing complications early in the course of the disease. The UKPDS demonstrated that there was . no deleterious effect of hyperinsulinaemia per se but the insulin therapy caused more weight increase than other agents. Hypoglycaemia which was mild was reported in 30% of patients per annum but major hypoglycaemia was only 2 to 3% per annum. The UKPDS demonstrated that many patients will need to be transferred to insulin therapy if glycaemia targets are to be achieved. Patients will require intensive treatment if they are to avoid the legacy of devastating complications.