Review Article

Treating the Whole Patient for Optimal Management of Type 2 Diabetes: Considerations for Insulin Therapy

Authors: Carlos Campos, MD, MPH


Primary care physicians are responsible for providing healthcare to most patients with type 2 diabetes. In this role, it is critical that physicians utilize a whole-patient treatment approach that includes lifestyle modifications and pharmacotherapy aimed to achieve glycemic control, in addition to the management of any comorbid conditions or risk factors for cardiovascular complications of diabetes. Due to the progressive nature of the disease, most patients with type 2 diabetes will eventually require insulin to achieve and maintain glycemic control, because of both increased insulin resistance and diminished secretory capacity of the pancreatic β cells. Thus, physicians need to be knowledgeable about and comfortable with the use of insulin, as well as with educating patients and discussing any potential barriers to insulin therapy. The use of a stepwise approach—beginning with basal insulin therapy and adding prandial insulin if necessary—is simple, effective, and appropriate for use in many patients.

Key Points

* Traditional treatments for diabetes involve diet and exercise, followed by 1 or more oral antidiabetic medications to achieve glycemic control.

* Most patients with type 2 diabetes eventually will require insulin, due to the progressive nature of the disease, which results in both increasing insulin resistance and diminishing secretory capacity of the insulin-producing β cells.

* Basal insulin therapy with a long-acting insulin (such as insulin glargine) can help patients with type 2 diabetes improve their overall glycemic control and achieve recommended glycosylated hemoglobin A1c goals (ie <7.0%), thereby reducing the risk of diabetic complications and improving quality of life.

* Education of patients about proper self-monitoring of blood glucose, in conjunction with discussions of how to recognize, avoid, and treat the symptoms of hypoglycemia, may be helpful in addressing the fear of hypoglycemia as a potential barrier to treatment.

* It is important to explore the potential barriers to treatment with each patient and enlist family members to help encourage the patient to accept and adhere to the treatment regimen.

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