Progression of type 2 diabetes and insulin initiation.

The prevalence of type 2 diabetes is significantly greater among African Americans compared to some other ethnic groups. The reasons for this increased incidence are due at least in part to the increased frequency of obesity, especially among African American women. The onset of hyperglycemia, after many years of insulin resistance, is due to beta cell dysfunction that slowly progresses to beta cell failure, necessitating insulin replacement. The timely initiation of insulin therapy is a critical clinical decision for treating physicians managing patients, especially when the patient is hesitant to begin insulin therapy. The availability of various insulin formulations gives the opportunity to tailor insulin therapy based on a patient's personal insulin requirements and lifestyle. Specific issues related to insulin therapy such as patient preferences, quality of life, barriers to the addition of insulin to the treatment regimen, and the effectiveness of insulin therapy are illustrated using a case study.