It is commonly felt that patients with type
II diabetes treated with oral therapy alone rarely achieve the recommended 7%
HbA1c goal for glycemic control. As control worsens over time, the risks of the
complications which are common to the diabetic patient increase.
Traditionally doctors can be loathe to use
insulin therapy in the type II diabetic patient (for a variety of reasons), and
when insulin is prescribed, it is often not prescribed in a sufficiently
aggressive dosage.
A recent survey has shown that supplementing
oral therapy with a single injection of insulin given at bed time can routinely
lower fasting glucose measurements, and achieves and surpasses the recommended
target of 7% for HbA1c levels.
Furthermore the use of glargine (a new
long-acting insulin analog) rather than more traditional insulin analogues can
achieve this reduction in fasting glucose measurements and HbA1c levels whilst
significantly reducing the incidence of nocturnal hypoglycaemia; with about a
third of all patients having no incidents of nocturnal hypoglycaemia at all.
With patient adherence to the treatment protocol exceeding 90%, this regimen is
easy to follow.
