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Review
. 2024 May;15(5):1085-1098.
doi: 10.1007/s13300-024-01569-8. Epub 2024 Apr 4.

The Current and Future Role of Insulin Therapy in the Management of Type 2 Diabetes: A Narrative Review

Janet B McGill  1 , Irl B Hirsch  2 , Christopher G Parkin  3 , Grazia Aleppo  4 , Carol J Levy  5 , James R Gavin 3rd  6
Affiliations
Review

The Current and Future Role of Insulin Therapy in the Management of Type 2 Diabetes: A Narrative Review

Janet B McGill et al. Diabetes Ther. 2024 May.

Abstract

Early initiation of intensive insulin therapy has been demonstrated to be effective in controlling glycemia and possibly preserving beta-cell function. Innovations in insulin formulations and delivery systems continue. However, we have seen an acceleration in the development of new classes of diabetes medications for individuals with type 2 diabetes and obesity, such as, for example, glucagon-like peptide-1 receptor agonists (GLP-1 RAs). These formulations have been shown to confer significant benefits in achieving good glycemic control with reduced hypoglycemia risk, weight loss, and cardiorenal protection. Therefore, it is reasonable to question whether there is still a role for insulin therapy in the management of type 2 diabetes. However, there are clear limitations inherent to GLP-1 RA therapy, including high rates of suboptimal adherence and treatment discontinuation due to high cost and side effects, which diminish long-term efficacy, and supply issues. In addition, newer formulations have shown improvements in convenience and tolerability, and have been shown to be even more effective when used in conjunction with basal insulin. In this narrative review, we discuss current evidence that supports GLP-1 RA use in combination with insulin therapy and the potential pitfalls of reliance on GLP-1 RAs as a substitute for insulin therapy.

Keywords: Adherence; Discontinuation; GLP-1 RA; Glucagon-like peptide-1 receptor agonists; HbA1c; Insulin; Type 2 diabetes.

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Conflict of interest statement

Janet B McGill has received research support from the NIH, Helmsley foundation, JDRF, Novo Nordisk, and Beta Bionics. JBM has received consulting fees from Bayer, Boehringer Ingelheim Lilly, Mannkind, Novo Nordisk, and Thermo Fisher outside of this work. Irl B Hirsch reports grant support from Dexcom, Tandem, and Mannkind; and consulting fees from Abbott Diabetes Care, Roche, Hagar, and Vertex. Christopher G Parkin has received consulting fees from Abbott Diabetes Care, CeQur, Dexcom, Embecta, GWave, LifeScan, Insulet, Tandem, Mannkind, Roche Diabetes Care, and Provention bio. Grazia Aleppo has received research support to Northwestern University from Astra-Zeneca, Dexcom, Eli-Lilly, Emmes, Fractyl Health, Insulet, MannKind, Novo Nordisk, Tandem Diabetes Care, and WellDoc; and consulting fees from Eli -Lilly, Dexcom, and Insulet outside of this work. Carol J Levy has received research support by the NIDDK and Helmsley Foundation and industry support paid to the Icahn School of Medicine at Mount Sinai from Abbott Diabetes, Dexcom, Insulet, Novo Nordisk, Senseonics; and Tandem; and consulting fees from Eli-Lilly and Dexcom outside of this work. James R. Gavin, III, has served on advisory boards and/or speaker bureaus for Abbott Diabetes Care, Novo Nordisk, Medtronic, and Boehringer Ingelheim.

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