Rationale for Timely Insulin Therapy in Type 2 Diabetes Within the Framework of Individualised Treatment: 2020 Update

Area of Science:

• Endocrinology
• Metabolic Diseases
• Pharmacology

Background:

• Type 2 diabetes is defined by chronic hyperglycemia, insulin resistance, and beta-cell dysfunction.
• Hyperglycemia and elevated fatty acids contribute to glucolipotoxicity, impairing beta-cell function and survival.
• Chronic hyperglycemia fuels insulin resistance, inflammation, and pro-atherogenic processes, increasing complication risks.

Purpose of the Study:

• To review indications for early insulin treatment in type 2 diabetes.
• To explore insulin's role in preventing diabetes-related complications and preserving beta-cell function.
• To analyze individualized, risk-benefit-balanced insulin initiation strategies.

Main Methods:

• Review of current guidelines and literature on type 2 diabetes management.
• Analysis of patient subgroups requiring early insulin intervention.
• Evaluation of basal insulin as a preferred initial option.

Main Results:

• Timely insulin initiation can prevent diabetes progression and reduce micro- and macrovascular complications.
• Early insulin therapy may lead to recovery of residual beta-cell function.
• Basal insulin is often the preferred choice, addressing undertreatment of chronic hyperglycemia.

Conclusions:

• Patient-centered, risk-benefit-balanced insulin therapy is essential for managing type 2 diabetes.
• Early and timely insulin initiation is vital for preventing long-term diabetes complications.
• Basal insulin offers a practical approach for most patients, mitigating risks of undertreatment.