Continuation of Oral Medications When Insulin Is Initiated

Authors: Joshua J. Neumiller, PharmD, CDE, CGP, FASCP, Stephen M. Setter, PharmD, CGP, CDE, FASCP


Type 2 diabetes mellitus (T2DM) is a progressive disease characterized by insulin resistance and progressive β-cell dysfunction.1 With the prevalence of T2DM increasing, particularly in younger populations, the use of insulin will become increasingly important as patients develop severe insulinopenia due to a progressive loss of pancreatic β-cell function. The decision to initiate insulin therapy in many patients with T2DM is not always clear, with considerations for any given patient being quite diverse, and often complex. The clinician's views, experiences, and comfort level with the initiation and management of insulin in patients with T2DM often dictates their “resistance” or “acceptance” of utilizing insulin at appropriate times during patient management.2 All too often “insulin resistance” is provider driven.2 Therefore, once the clinical decision is made to intensify therapy in patients with T2DM, oral therapies are often sought in lieu of insulin due to increased acceptance by patients (and by many providers) and less intense patient management and follow-up requirements, including the adjustment of concomitant oral antidiabetic agents. The article in this issue of SMJ titled “The Continuation of Oral Medications with the Initiation of Insulin Therapy in Type 2 Diabetes” provides a review and summary of the literature in regard to the efficacy, safety, and costs associated with the continuation of oral antidiabetic agents in combination with insulin.3 The authors point to the lack of guidance regarding the continuation or discontinuation of oral medications following insulin initiation and have thus undertaken the arduous task of summarizing currently available clinical trial data involving insulin use in conjunction with each major class of oral antidiabetic agents used in the management of T2DM.

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