Insulin strategies for type 2 diabetes mellitus

Objective: To review the currently available insulin analogs and the benefits of insulin therapy in the treatment of type 2 diabetes mellitus. Data Sources: A MEDLINE search (1990-March 2004) was conducted using insulin and type 2 diabetes mellitus as search terms to identify clinical trials and review articles. The bibliographies of identified articles were reviewed. Study Selection and Data Extraction: All articles identified from the data sources were evaluated and deemed relevant if they included and assessed clinical outcomes. Data Synthesis: Since its discovery in 1922, insulin therapy has been the only available pharmacologic treatment for type 1 diabetes and a mainstay therapy for patients with type 2 diabetes who fail to obtain glycemic control with oral antidiabetic agents. This article reviews the current insulin analogs available on the market and insulin regimens that are designed to mimic the pancreatic beta-cells' response to a glucose load. Conclusions: Insulin therapy is often withheld until late in the disease process for patients with type 2 diabetes mellitus. This results in an enormous burden of disease for patients. Insulin therapy is beneficial in obtaining glycemic control and may attenuate the complications associated with diabetes.