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Rebuttal by Dr Garber
Alan J. Garber, MD, PhD
Arch Intern Med. 2003;163:1785.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. |
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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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