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Insulin and Oral Hypoglycemic Agents Should Not Be Used in Combination in the Treatment of Type 2 Diabetes
Sydney A. Westphal, MD;
Pasquale J. Palumbo, MD
Arch Intern Med. 2003;163:1783-1785.
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CURRENT TREATMENT paradigms for type 2 diabetes mellitus usually relegate insulin to the position of a last option, for patients in whom monotherapy or combination therapy with oral agents has failed. When insulin is used in this scheme, the common practice is to add it to the oral agent regimen rather than use it by itself. However, this treatment approach does not recognize the natural course of type 2 diabetes and the importance of tight glycemic control. Very often, less than optimal glycemic control is the consequence of maintaining oral agents in the management of type 2 diabetes.
The etiology of type 2 diabetes involves both peripheral resistance to insulin and defective  -cell function.1 When the cells fail to maintain an adequate insulin supply in the face of insulin resistance, hyperglycemia and then the development of type 2 diabetes occur. Data from . . . [Full Text of this Article]
From the Departments of Medicine, Maricopa Medical Center, Phoenix, Ariz (Dr Westphal), and Mayo Clinic Scottsdale, Scottsdale, Ariz (Dr Palumbo). The authors have no relevant financial interest in this article.
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Arch Intern Med. 2003;163(15):1781-1782.
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Rebuttal by Dr Garber
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Arch Intern Med. 2003;163(15):1785.
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