[Insulin therapy in type 2 diabetes]

As compared to type 1 diabetes, type 2 diabetes usually requires insulin at a late stage, after secondary failure to oral antidiabetic drugs. However, it should be pointed out that insulin therapy should not be delayed in patients not well controlled on oral agents. Type 2 diabetic patients failing to oral antidiabetic medications need insulin. Nevertheless, insulin therapy in type 2 diabetic patients is less standardized than in those with type 1 diabetes. Several clinical trials tried to investigate what is the most appropriate initial insulin therapy in type 2 diabetic patients, with the main objectives of reaching almost normoglycaemia without increased risk of frequent or severe hypoglycaemic episodes. However, there is no agreement upon optimal mode of initiating insulin. The most important factors leading to adequate metabolic control are a global educational approach together with a intensified follow up, independently of the insulin regimen.