Insulin initiation in type 2 diabetes

Large-scale clinical trials have demonstrated that metabolic control achieved early in the course of diabetes can substantially help preventing the onset and slowing down the progression of diabetes and the associated microvascular complications. Various strategies incorporating the use of insulin early in the course of the disease have been developed to meet this goal and to compensate for the progression of β-cell failure. We believe that insulin suppresses inflammation and also reduces glucotoxicity and lipotoxicity, and thus exerts a pivotal and beneficial role. Comprehensive metabolic control, especially when instituted earlier, may alter the natural history of diabetic complications. Therefore, physicians are encouraged to take early and intensive interventions with insulin therapy for patients with type 2 diabetes, especially when attempting to induce "remissions" or in patients suboptimally controlled with oral medications. Key words: Diabetes mellitus; type 2; Insulin therapy; Early intervention; β-cell function