Early insulin therapy in patients with type 2 diabetes mellitus

Abstract

Type 2 diabetes mellitus (T2DM) is a progressive disease characterised by beta cell dysfunction and insulin resistance. Beta cell dysfunction progresses to beta cell failure. Many patients with T2DM are managed with oral agents until complications develop. ‘Clinical inertia’ in T2DM, defined as lack of initiation or intensification of therapy when clinically indicated, is common among clinicians. Patients are exposed to hyperglycaemia for a long time resulting in glucotoxicity to beta cells, leading to further beta cell deterioration. The traditional approach to the management of T2DM is lifestyle change, diet, exercise, weight loss, oral agents and, lastly, insulin. This traditional approach is usually carried out step-by-step and at a slow pace, with insulin offered as a last option. By the time insulin therapy is initiated, complications have already developed. It is, therefore, important for clinicians to be aware of the importance of initiating insulin therapy early to prevent poor glycaemic control and the development of diabetes-related complications.