Consequences of delaying progression to optimal therapy in patients with type 2 diabetes not achieving glycemic goals

South Med J. 2009 Jan;102(1):67-76. doi: 10.1097/SMJ.0b013e318182d8a2.


As a result of the progressive nature of diabetes, glycemic control deteriorates with time, and the risk of associated complications increases. To delay the onset of complications, effective antihyperglycemia therapy should be initiated as soon as possible after diagnosis. Insulin is the most efficacious therapy for diabetes, but its administration is often delayed. This delay, which adversely affects patients' long-term prognosis, stems partly from clinical inertia and psychological factors affecting both patients and physicians, and partly from a treatment paradigm that advocates the sequential addition of oral interventions before eventual insulin initiation. Starting insulin therapy sooner can help to minimize complications, and modern insulin formulations, used in a well-designed treatment regimen with modern delivery devices, can help patients take advantage of this effect, with minimal hypoglycemia and weight gain.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Disease Progression
  • Dosage Forms
  • Drug Therapy, Combination
  • Glycated Hemoglobin A / metabolism
  • Guideline Adherence
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / therapeutic use*
  • Insulin / administration & dosage
  • Insulin / therapeutic use*
  • Practice Guidelines as Topic


  • Dosage Forms
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin