The role of insulin

SUMMARY The ability of nonpharmacologic and oral pharmacolog-ic therapies to maintain glycemic control in type 2 dia-betes almost invariably dissipates. Insulin therapy, there-fore, is eventually needed in the majority of patients withtype 2 diabetes. While many options are available, thenewer insulin analogs (insulin glargine, biphasic insulinaspart 70/30, and 75% insulin lispro protamine/25%insulin lispro), which more closely mimic the releaseand action of endogenous insulin in healthy persons,offer several advantages over conventional humaninsulins. Comprehensive care for the person with type 2diabetes includes diabetes education, ongoing adjust-ments and changes to therapy, and self-managementsupport guided by appropriate monitoring and screen-ing for the complications of diabetes. REFERENCES 1. Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease innon-insulin dependent diabetes mellitus: United Kingdom Prospective DiabetesStudy (UKPDS: 23). BMJ . 1998;316:823-828.2. Stevens RJ, Coleman RL, Adler AI, Stratton IM, Matthews DR, Holman RR. Riskfactors for myocardial infarction case fatality and stroke case fatality in type 2 dia-betes: UKPDS 66.