Initiating insulin in patients with type 2 diabetes

Type 2 diabetes has become a worldwide epidemic and is associated with multiple complications that can be prevented by modifying risk factors and optimizing glycemic control. The optimization of glycemic control often requires the use of multiple agents, including insulin. Insulin is an important component of anti-hyperglycemic therapy, yet there are many perceived barriers. Existing guidelines do not specifically address the topic of insulin initiation. We review and analyze the evidence from randomized controlled trials on insulin initiation and address adverse effects and barriers. We also discuss the selection of an insulin regimen, titration and delivery of care, as well as when and how to combine insulin therapy with oral antihyperglycemic agents. 99 references