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Alan J. Garber, MD, PhD

Arch Intern Med. 2003;163:1785.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

THE PRIMARY dysfunction that determines the degree of hypoglycemia in type 2 diabetes mellitus, ie, progressive loss of -cell function, clearly dictates that insulin treatment will ultimately prove necessary to preserve glycemic control in patients with long-standing disease. Soon after the initial diagnosis of type 2 diabetes, during the period of retained but lessened -cell function, insulin monotherapy may only be appropriate in special circumstances, eg, in patients with extreme hyperglycemia, glucose toxicity, islet cell antibodies, a history of ketoacidosis, or pregnancy. However, the evidence-based literature is clear that combination therapy of oral agents with insulin is superior to insulin therapy alone in most moderate to advanced cases of type 2 diabetes.^1-3 Combination therapy with insulin and oral agents can limit weight gain and insulin dosage, and provide benefits that insulin alone cannot provide, such as reducing high triglyceride and very-low-density lipoprotein cholesterol levels, which . . . [Full Text of this Article]

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