Combining insulin and oral agents in diabetes: indications and controversies

Patients with noninsulin-dependent diabetes demonstrate peripheral insulin resistance that is aggravated by increased hepatic glucose production and results in elevated serum insulin and serum glucose levels. These levels can be affected by intensive diabetic management, including diet, exercise, lifestyle modifications and insulin or sulfonylurea therapy. Sulfonylureas stimulate endogenous insulin production, increase peripheral sensitivity to insulin and suppress hepatic glucose production. In spite of its added expense, increased potential for side effects and questionable efficacy, combination therapy with insulin and a sulfonylurea is often considered in noninsulin-dependent diabetics with difficult-to-control disease.