[Combined therapy in non-insulin-dependent diabetes mellitus]

In recent years an improved understanding of potential complications associated with hyperinsulinemia has led to a growing interest in alternatives to insulin monotherapy for patients with non-insulin-dependent diabetes mellitus, who have failed on a regimen of diet and sulphonylureas. These patients typically present normal or elevated levels of insulin. This problem which has been attributed to insulin resistance, is superimposed on the peripheral hyperinsulinemia resulting from subcutaneous insulin delivery. A plethora of clinical trials have reported on the efficacy of combining therapy in limiting insulin requirements while achieving better glycemic control. This paper attempts a critical review of the pros and cons with respect to combining therapy and provides guidelines for its practical use.