Can glycemic targets be achieved - In particular with two daily injections of a mix of intermediate- and short-acting insulin?

Objective: To present data that demonstrate the feasibility of using twice-daily insulin injections, in combination with selected orally administered agents, to achieve glycemic targets in patients with type 2 diabetes. Methods: Recent studies of the effects of various therapeutic strategies in patients with type 2 diabetes are reviewed, and the rationale for and recommended approaches in the use of combination treatment to achieve glycemic goals are discussed. Results: The combination of insulin and insulin sensitizers is an effective option for achieving glycemic goals (hemoglobin A1c ≤ 6.5%). Although thiazolidinediones are better sensitizers than metformin, they are associated with significant weight gain. In contradistinction, metformin, an effective insulin sensitizer, causes less weight gain. The sequence in which these two sensitizers are added to insulin therapy is important; if metformin is added before a thiazolidinedione, weight gain may be avoided. Conclusion: Glycemic targets can be achieved with use of twice-daily mixtures of intermediate- and short-acting insulin in a high percentage of patients with type 2 diabetes.