Insulin status and adjustment in type 2 diabetic patients' treatment.

Introduction. -The natural history of type 2 diabetes mellitus is character ized by an inescapable and gradual worsening of a decrease in insulin secre ction. Thus after several years of progress, less than half of type 2 diabe tic patients have good glycemic control. This explains the increase in insu lin prescription to type 2 diabetic patients in France in recent years. Thi s work's objective is to take into account recent publication data to clari fy the status of and adjustments in insulin therapy. Current knowledge and key points. -The benefit of insulin treatment-mediate d glycemic control optimization on microvascular complications is now prove n. However, there is still controversy concerning macrovascular complicatio ns. Hypoglycemic risk in type 2 diabetic patients is limited and the main p roblem with insulin treatment is weight gain. Following failure with treatm ent by tablets, the most suitable treatment in terms of metabolic improveme nt, weight gain limitation and treatment adhesion is to add an intermediate insulin injection at bedtime. The next step remains several injections a d ay, with metformine addition if possible. Future prospects and projects. -Therapeutic treatment in type 2 diabetes me llitus may become an earlier start of insulin therapy to preserve the remai ning pancreatic insulin reserve. The role of brief and long-lasting insulin analogues, as well as inhaled insulin, which will soon be available, shoul d be specified. (C) 2001 Editions scientifiques et medicales Elsevier SAS.