Initiating insulin in patients with type 2 diabetes

Area of Science:

• Endocrinology
• Metabolic Diseases
• Public Health

Background:

• Type 2 diabetes mellitus (T2DM) affects 7% of the US population, rising to 20% in those 60 and older.
• The increasing prevalence of obesity contributes to a higher incidence of T2DM, even in younger individuals.
• Insulin resistance and impaired glucose tolerance precede T2DM diagnosis by years.

Observation:

• Beta-cell function initially compensates for insulin resistance with hyperinsulinemia.
• Progressive loss of first-phase insulin response leads to elevated postprandial glucose (PPG).
• Fasting plasma glucose (FPG) levels eventually exceed 126 mg/dL, indicating clinical diabetes.

Findings:

• As T2DM advances, beta-cell function declines, necessitating more intensive therapeutic interventions.
• Patients can slow T2DM progression through sustained lifestyle modifications.
• Despite management efforts, pancreatic function decline is inevitable, often requiring medication adjustments.

Implications:

• Family physicians must educate patients about T2DM disease progression at diagnosis.
• Patients should understand that while progression can be slowed, it cannot be halted.
• Emphasizing that disease progression is natural can help patients avoid self-blame when adhering to management plans.