Insulin as initial therapy in type 2 diabetes: Effective, safe, and well accepted

Ildiko Lingvay, Polina F. Kaloyanova, Beverley A Huet, Karin Salinas, Philip Raskin

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: To achieve glycemic control in type 2 diabetes mellitus (T2DM), multiple oral agents are used in a stepwise approach, but long-term maintenance of normoglycemia is difficult to achieve, and, eventually, most patients require insulin. The aim of this study was to evaluate the feasibility, acceptability, and efficacy of insulin with metformin for newly diagnosed, treatment-naive patients with T2DM. Methods: Eligible patients were started on insulin NovoLog 70/30 and metformin 1,000 mg twice daily. Biochemical evaluation was performed at baseline and at the end of the 3-month study. Patients were seen monthly to assess side effects and compliance and make insulin dose adjustments. Patient treatment satisfaction was evaluated at the end of the study. Results: Of 63 patients, 92% completed the study. The hemoglobin A 1c (HbA1c) decreased from 10.8 to 5.9% (p < .0001), and 100% of subjects achieved an HbA1c < 7%. Weight increased from 100.0 to 101.6 kg (p = .004) but was less than expected given that patients lost an average of 7.2 kg prior to diagnosis and achieved a reduction in HbA 1c of 5%. The rate of hypoglycemia was low (1.5 episodes/patient- month). Ninety-seven percent of the patients were satisfied with their insulin treatment, and 88% were willing to continue insulin. Compliance was 96.5% with insulin and 95.1% with metformin. Conclusion: Outpatient initiation of insulin therapy at the time of diagnosis of T2DM is an effective, safe, and feasible strategy for rapidly lowering HbA1c levels to targets. Insulin was very well accepted by the patients, refuting the misconception of low satisfaction and acceptance of such treatment.

Original languageEnglish (US)
Pages (from-to)62-68
Number of pages7
JournalJournal of Investigative Medicine
Issue number2
StatePublished - Mar 2007


  • Insulin therapy
  • Newly diagnosed type 2 diabetes mellitus
  • Quality of life
  • Treatment satisfaction

ASJC Scopus subject areas

  • General Biochemistry, Genetics and Molecular Biology


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