Clarifying the Role of Insulin in Type 2 Diabetes Management

Clarifying the Role of Insulin in Type 2 Diabetes Management John R. White, Jr. , PA-C, PharmD , Stephen N. Davis , MD, FRCP , Ramachandiran Cooppan , MD , Mayer B. Davidson , MD , Kathryn Mulcahy , RN, MSN, CDE , Gary A. Manko , MD , Donald Nelinson , PhD and the Diabetes Consortium Medical Advisory Board Abstract In Brief The prevalence of type 2 diabetes has been increasing rapidly and with it has been resultant morbidity and mortality. Strict glycemic control reduces the progression of diabetic microvascular disease; however, most patients treated with sulfonylureas require additional insulin therapy. This article addresses common clinician concerns about prescribing insulin early in type 2 diabetes. It presents strategies for incorporating basal insulin therapy with glargine (Lantus) into a regimen that promotes compliance. Footnotes John R. White, Jr., PA-C, PharmD, is a professor at Washington State University College of Pharmacy in Spokane. Stephen N. Davis, MD, FRCP, is chief of the Division of Diabetes, Endocrinology, and Metabolism at Vanderbilt University Medical School in Nashville, Tenn. Ramachandiran Cooppan, MD, is an assistant clinical professor at Harvard Medical School in Boston, Mass. Mayer B. Davidson, MD, is director of the Clinical Trials Unit at Charles R. Drew University in Los Angeles, Calif. Kathryn Mulcahy, RN, MSN, CDE, is program director of the INOVA Diabetes Center in Fairfax, Va. Gary A. Manko, MD, is president of Clinical Associates, PA, in Reisterstown, Md. Donald Nelinson, PhD, is executive director of the Diabetes Consortium. The Diabetes Consortium, Inc., is a nonprofit, multidisciplinary collaboration dedicated to the development and dissemination of professional and patient initiatives implementing optimal diabetes care. For more information, write to: P.O. Box 8262, Parsippany, NJ, 07054-8262, or call 877-462-4356. Note of disclosure: Dr. White has served on an advisory board for Aventis; has received honoraria for speaking engagements from Aventis, Takeda, Omron, Pfizer, and TheraSense; and has received research support from Aventis. Dr. Cooppan has received honoraria from Bristol-Myers Squibb, Pfizer, Aventis, Novartis, Takeda, Eli Lilly, GlaxoSmithKline, and Wyeth-Ayerst. Ms. Mulcahy has served on advisory boards and received honoraria from Aventis and Novo Nordisk. Dr. Manko has received honoraria from Pharmacia, Wyeth-Ayerst, and Bristol-Myers Squibb. All of these companies manufacture or market insulin or othe