[Step-wise drug therapy in type 2 diabetes mellitus]

After diagnosis of type 2 diabetes mellitus, a careful education of the patient as well as diet consulting is necessary especially when body weight should be reduced. When these steps do not achieve an adequate metabolism, insulinotropic substances (sulphonyl urea or repaglinid) as well as biguanides and inhibitors of the disaccaridase (acarbose and meglitol) are available for further treatment. In the future, thiazolidindione may be applied which primarily increases the sensitivity for insulin. All these drugs may be combined with insulin application once or more often a day i.e. by the bolus principle. Mostly in older patients however, a conventional insulin therapy with a fixed daily rhythm has to be recommended when oral antidiabetic agents fail. When a patient asks for more flexibility, one should not hesitate to teach even the older patient the intensified insulin therapy.