Reaching glycaemic targets while minimizing hypoglycaemia in insulin-treated type 2 diabetes patients

Type 2 diabetes mellitus (T2DM) is a progressive disease characterized by both insulin resistance and beta-cell failure, resulting in a decline in insulin secretion and increased blood glucose levels. By the time T2DM is clinically diagnosed, only 50% of normal beta-cell function remains, leading to altered control of fasting and/or postprandial glucose. The aim of this review is to summarize the options for introduction of basal insulin, in particular insulin glargine, and the advantages and disadvantages of using insulin glargine vs. alternative insulins or vs. oral agents. Overall, the studies included in this review show that insulin glargine is associated with a lower risk of hypoglycaemia vs. both neutral protamine Hagedorn insulin and premixed insulin formulations, alongside clinically important improvements in glycaemic control. Furthermore, insulin glargine is associated with greater improvements in glycaemic control vs. intensification of oral therapy. Thus, insulin glargine should be a preferred option when starting insulin therapy for people with T2DM.