Early and Aggressive Initiation of Insulin Therapy for Type 2 Diabetes: What Is the Evidence?

  1. Kevin Niswender, MD, PhD


    Type 2 diabetes is a progressive disease in which b[beta symbol]-cell function continually declines and eventually fails, ultimately requiring nearly all patients to be placed on insulin therapy. An increasing body of evidence suggests that early intensive glycemic control reduces long-term vascular outcomes and potentially may prolong b[beta symbol]-cell lifespan and function. Herein, evidence in favor of early insulin therapy on disease progression and long-term outcomes will be reviewed and placed into clinical context.


    • Kevin Niswender, MD, PhD, is a staff physician in the Department of Veterans Affairs Tennessee Valley Healthcare System and an assistant professor in the Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism at Vanderbilt University School of Medicine, in Nashville, Tenn.

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