The major barriers for some physicians to use insulin in the treatment of type 2 diabetes are
■ the misconception that insulin therapy may increase the risk of cardiovascular disease
■ excessive concerns with weight gain
■ the potential risk of hypoglycemia
■ the inconvenience of having to instruct and persuade the patients to take injections
Traditionally, insulin therapy has been considered a therapy of last resort in type 2 diabetes due to these concerns and the lack of understanding that insulin deficiency is one of the initial defects that worsen with the progressive nature of the disease (Table 1).
Initiation of insulin therapy is typically associated with weight gain. The weight gain is most rapid in the first 3 to 6 months of therapy and is correlated with improvements in glycemic
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