Many patients with type 2 diabetes eventually require insulin to maintain glycemic control. Researchers in Finland who analyzed dozens of research studies to determine what regimen is best when it is time to add insulin concluded that insulin in combination with an oral drug provides the greatest benefits.

Glycemic control was better with insulin combination therapy; no study reported worse glycemic control with combination therapy than with insulin alone. A simple regimen such as insulin glargine, or NPH or lente or ultralente, plus a sulfonylurea or metformin seems to be optimum. Combinations of bedtime insulin and daytime metformin or sulfonylureas are associated with a lower HbA1c, fewer hypoglycemic episodes, and less weight gain. Also, using a combination permits fewer insulin injections, which may improve compliance. The researchers noted that the prevailing view that patients who do not respond well to combination therapy will benefit by adding additional insulin injections is not supported by the data. Instead, the dose of the single long-acting insulin should be increased to one that normalizes the fasting glucose concentration.

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