PURPOSE: The purpose of this review was to document the need for, barriers to, and available treatment options for patients with type 2 diabetes, with a focus on modern insulins and delivery systems. DATA SOURCES: Extensive review of the scientific literature was carried out, concentrating on data supporting the need for tight glycemic control, and efficacy and safety data on oral antidiabetes agents, insulins (particularly insulin analog therapies), incretins, and insulin delivery devices. CONCLUSIONS: Nurse practitioners and other clinicians need to be aware of the urgent need to help patients optimize glycemic control using therapies that can bring blood glucose levels within the target range throughout the day. Choice of therapy must take into account anticipated hemoglobin A(1c) decrease, tolerability, effect on comorbid conditions, and cost. As diabetes progresses, insulin is the only hypoglycemic agent with unlimited potential to lower blood glucose; earlier initiation of insulin therapy can help many patients achieve glucose targets more rapidly and provide symptomatic relief. Modern insulins and related therapies in conjunction with innovative delivery devices, appropriate counseling, and patient education can help overcome many barriers to insulin therapy. IMPLICATIONS FOR PRACTICE: The incidence of type 2 diabetes is increasing at an alarming rate. More aggressive treatment, based on the pathophysiology of the disease, is necessary and should include greater attention to control both fasting and postmeal glucose excursions, as well as earlier introduction of insulin therapy that is both effective and acceptable to patients. The educated use of oral antidiabetes agents, modern insulin analogs, incretin agents, and innovative delivery devices can help many patients achieve blood glucose targets in a scientifically logical manner that takes into account a patient's lifestyle needs.
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