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Insulin therapy in type 2 diabetes.

Trent Davis¹, Steven V Edelman

¹Section of Diabetes/Metabolism, Veterans Affairs San Diego HealthCare System, 3350 La Jolla Village Drive 111G, San Diego, CA 92161, USA.

The Medical Clinics of North America

|August 17, 2004

Summary

Type 2 diabetes management differs from type 1. Early stages involve insulin resistance, improved by lifestyle changes and oral agents, while later stages necessitate insulin therapy for optimal glucose control.

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Area of Science:

Endocrinology
Metabolic Diseases
Diabetes Mellitus Research

Background:

Type 1 diabetes is characterized by absolute insulin deficiency requiring immediate insulin therapy.
Type 2 diabetes initially presents with insulin resistance and hyperinsulinemia, distinguishing it from type 1.
Effective management of type 2 diabetes evolves from lifestyle interventions to pharmacotherapy and eventually insulin replacement.

Purpose of the Study:

To outline the distinct pathophysiological progression of type 2 diabetes compared to type 1.
To emphasize the importance of improving insulin sensitivity in early type 2 diabetes.
To highlight the therapeutic strategies for glycemic control in type 2 diabetes across disease stages.

Main Methods:

Review of current understanding of type 2 diabetes pathophysiology.
Analysis of treatment modalities for type 2 diabetes based on disease progression.
Comparison of glycemic control objectives with type 1 diabetes.

Main Results:

Early type 2 diabetes management focuses on enhancing insulin sensitivity through diet, exercise, and weight loss.
Oral hypoglycemic agents are effective when lifestyle modifications are insufficient.
Late-stage type 2 diabetes typically requires exogenous insulin for achieving target glycemic and glycosylated hemoglobin levels.

Conclusions:

Glycemic control objectives for type 2 diabetes should align with those for type 1 diabetes, as recommended by the American Diabetes Association.
Therapeutic approaches for type 2 diabetes must be tailored to the stage of the disease, progressing from lifestyle interventions to insulin therapy.
Understanding the differences in insulin secretion and resistance between type 1 and type 2 diabetes is crucial for effective patient management.

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