Intensive initiation of insulin therapy in patients with newly diagnosed type 2 diabetes mellitus : a different take on current stepwise approaches

Abstract

Type 2 diabetes mellitus (T2DM), previously regarded as being a disease borne exclusively from following a poor lifestyle, affects at least 415 million individuals worldwide, a number which is believed will increase to 640 million by 2040. As our understanding of T2DM improved over time, it became clear that the condition is underpinned by interactions between poor lifestyle choices and highly varying genetic constructs that involve more than 400 genes. Although a comprehensive review of the genetic architecture of T2DM falls beyond the scope of the current paper, it suffices to say that failure to regard the pathophysiology of T2DM and its subsequent treatment from a drastically different perspective, will result in an increasing burden of the condition on society. This is especially realistic, since despite the fact that oral hypoglycaemic drugs have been used since 1955, current approaches fail to arrest the continuous global rise in the number of T2DM cases.