Trends in the Management of Type 2 Diabetes: An Emerging Role for Insulin

OBJECTIVES: This review is intended to explore the pathophysiology of type 2 diabetes, examine the role of insulin as a means of achieving glycemic control in people with type 2 diabetes, and provide a practical approach for insulin use in type 2 diabetes in the managed care setting. DATA SOURCES: This manuscript is based on the results of a MEDLINE literature search and presentations by the authors at a symposium titled, “Emerging Changes in Diabetes Management,” that took place on October, 14, 2004, at the Academy of Managed Care Pharmacy’s 2004 Educational Conference in Baltimore, Maryland. CONCLUSIONS: Despite advances in oral treatment, type 2 diabetes remains as substantial source of microvascular and macro vascular complications that cause unacceptable levels of morbidity, mortality, and cost. Accumulating clinical evidence suggests that insulin treatment, both basal and prandial, can advance the treatment of type 2 diabetes and reduce the risks for serious sequelae by providing consistent and optimal glycemic control. By more closely mimicking the actions of endogenous insulin, in terms of onset and duration of action, insulin analogues offer clear advantages over their regular insulin counterparts.