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Issues Relating To The Early Or Earlier Use Of Insulin In Type 2 Diabetes

P. Home, A. Boulton, J. T. Jiménez, R. Landgráf, B. Osterbrink, J. Christiansen
Published 2003 · Medicine

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Insulin therapy is increasingly being considered earlier in the management of people with type 2 diabetes. Its ability to achieve appropriate levels of glycaemic control and to maintain that control in the long term is not shared by other treatment options. The benefits of preventing deterioration to poorer levels of blood glucose control in order to avoid late complications of diabetes are now well established. Insulin also has a well-established safety profile. In spite of these and other advantages, a number of factors such as risk of hypoglycaemia, weight gain and, more controversially, the possibility of insulin-associated atherogenicity have been perceived as potential risks limiting its earlier use. Other factors, such as availability, needle phobia, dietary restriction, employment issues and economic considerations may also be seen as possible barriers. This review aims to address these issues in turn and, against this background, highlight the potential of earlier initiation of insulin therapy in the management of type 2 diabetes. It also attempts to identify which patients might benefit most from such a strategy. It is concluded that, in general, any possible risks or barriers (real or perceived) to the use of insulin should not discourage its early or earlier integration into the management of type 2 diabetes. Copyright © 2003 John Wiley & Sons, Ltd.
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