Despite insulin being the most effective medication for lowering HbA1c levels in people with type 2 diabetes there is significant inertia with regard to initiating treatment and titrating the dose. This article discusses when insulin should be initiated and how it can be titrated in the community.
The prevalence of type 2 diabetes around the world is increasing and is associated with significant morbidity and mortality from the microvascular and macrovascular complications of longstanding hyperglycaemia. Over the past 10 years many new classes of drugs have become available for treating type 2 diabetes. Despite these advances, insulin is still the most effective medication for reducing glycated haemoglobin (HbA1c) levels.1 Insulin is often initiated as a last resort when multiple oral hypoglycaemic agents have failed to achieve a target HbA1c level, despite evidence that optimal glycaemic control within the first 10 years after diagnosis has long-term benefits in terms of reduced risk of complications.2