Insulin Therapy for Type 2 Diabetes Mellitus

Insulin Therapy for Type 2 Diabetes Mellitus

The hemoglobin A1c target for most patients with type 2 diabetes is 7% 

 Ismail-Beigi et al: targed approximately 8%:  Increased risk of hypoglycemia, reduced life expectancy,

extensive comorbidities (renal/liver failure- alcohol abuse), cardiovascular diseases, DM duration or reduced resources. 

Insulin adverse effects include weight gain and hypoglycemia.

Basal insulin can be added to oral hypoglycemic agents (generally stopping sulfonylureas)

initially, and later, prandial insulin can be added in a stepwise fashion. 

1. Insulin Resistance: impaired ability to suppress hepatic glucose production a peripheral glucose uptake.

2. Progressive imparirment of insulin secretion.

ACCORD HBA1c less than 6,0% more harmfull. 7,0-7.9 % less hypoglicemia and mortality. 

DCCT/EDIC  Increase in HBA1c from 7% to 8%. Results in an absolute increase from 1 event per year to only 2 events per year of retinopathy progression. 

Lower HbA1c goals: younger, not developed hypoglycemia, and when the benefits of microvascular

disease protection outweigh the risks of hypoglycemia.