Defining the role of basal and prandial insulin for optimal glycemic control

Type 2 diabetes mellitus is a progressive disease characterized by early impairment of beta-cell function and ultimately loss of beta-cell mass. Hence, a single daily injection of a long-acting insulin is commonly initiated after intensification of oral antihyperglycemic therapy. Hemoglobin A1C should be measured every 3 months and therapy adjusted if the target is not met. As beta-cell function continues to decline, it is often necessary to add exogenous bolus insulin therapy, using short-acting insulin analogs or regular insulin. Alternatively, the use of pre-mixed insulin preparations, combining both long-acting and short-acting insulins, may be used.