Endocrine Abstracts (2009) 20 D1.2

Add insulin

Tadej Battelino

UMC-University Children’s Hospital, Ljubljan, Slovenia.

People with type 2 Diabetes (T2D) develop severe chronic complication early in the course of the disease if not treated optimally. Although lifestyle intervention and metformin clearly improve metabolic control with metformin having well established safety profile, both become insufficient in most patients with T2D. To achieve the current goal of HbA1c < 7% additional medication are introduced.

By current recommendations, basal insulin or sulfonylurea are added to lifestyle intervention and metformin in majority of patients, with intensive insulin therapy following when needed to maintain the target HbA1c. Alternatively, pioglitazone or GLP-1 agonist may be added to lifestyle and metformin in selected patients.

Data demonstrating the importance of regulating postprandial blood glucose early in the course of T2D may require modified clinical algorithms. Prandial insulin may be preferable for regulating postprandial blood glucose early in the course of T2D. Similarly, GLP-1 agonist may be beneficial in younger people with early stage T2D where weight reduction and regulation of the postprandial blood glucose can be primary goals.

Diversified clinical recommendations focusing on distinct sub-groups of people with T2D are warranted with more focus on regulating postprandial blood glucose, along with additional clinical trials to verify the emerging concepts.

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