Current treatment guidelines for T2DM note that basal insulin can be used throughout the progression of T2DM: •At diagnosis ( 15. Garber A.J. Abrahamson M.J. Barzilay J.I. et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2016 executive summary. Endocr Pract. 2016; 22: 84-113 Abstract Full Text Full Text PDF PubMed Google Scholar , 16. American Diabetes Association, Standards of medical care in diabetes--2016. Diabetes Care. 2016; 39: S1-S111 PubMed Google Scholar , 40. Owens D.R. Clinical evidence for the earlier initiation of insulin therapy in type 2 diabetes. Diabetes Technol Ther. 2013; 15: 776-785 Crossref PubMed Scopus (53) Google Scholar ). Insulin is the treatment of choice for newly diagnosed patients with severely elevated A1C and symptoms of hyperglycemia ( 15. Garber A.J. Abrahamson M.J. Barzilay J.I. et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2016 executive summary. Endocr Pract. 2016; 22: 84-113 Abstract Full Text Full Text PDF PubMed Google Scholar , 16. American Diabetes Association, Standards of medical care in diabetes--2016. Diabetes Care. 2016; 39: S1-S111 PubMed Google Scholar ). Other patients who are especially likely to benefit from initial insulin therapy include treatment-naïve individuals with hyperglycemic symptoms and A1C >8.5% and patients with latent autoimmune diabetes ( 40. Owens D.R. Clinical evidence for the earlier initiation of insulin therapy in type 2 diabetes. Diabetes Technol Ther. 2013; 15: 776-785 Crossref PubMed Scopus (53) Google Scholar ). Notably, with appropriate dose adjustment, insulin can be used in any patient, even those with hepatic or renal impairments or other comorbidities preventing the use of other classes of antihyperglycemic agents ( 1. U.S. Food and Drug Administration. Drugs@ FDA: FDA approved drug products. http://www.accessdata.fda.gov/Scripts/cder/ DrugsatFDA/Date accessed: August 6, 2016 Google Scholar ). •In combination with noninsulin agents ( 1. U.S. Food and Drug Administration. Drugs@ FDA: FDA approved drug products. http://www.accessdata.fda.gov/Scripts/cder/ DrugsatFDA/Date accessed: August 6, 2016 Google Scholar , 15. Garber A.J. Abrahamson M.J. Barzilay J.I. et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2016 executive summary. Endocr Pract. 2016; 22: 84-113 Abstract Full Text Full Text PDF PubMed Google Scholar , 16. American Diabetes Association, Standards of medical care in diabetes--2016. Diabetes Care. 2016; 39: S1-S111 PubMed Google Scholar , 41. Diabetes Care. 2016; 39: 973-981 Crossref PubMed Scopus (67) Google Scholar ). The American Association of Clinical Endocrinologists (AACE) recommends adding insulin when patients with T2DM are unable to attain glycemic control using ≥2 noninsulin agents ( 15. Garber A.J. Abrahamson M.J. Barzilay J.I. et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2016 executive summary. Endocr Pract. 2016; 22: 84-113 Abstract Full Text Full Text PDF PubMed Google Scholar ), and the American Diabetes Association (ADA) recommends basal insulin as one of several options to consider in patients unable to attain glycemic control with metformin ( 16. American Diabetes Association, Standards of medical care in diabetes--2016. Diabetes Care. 2016; 39: S1-S111 PubMed Google Scholar ). Using noninsulin agents such as metformin and a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in combination with basal insulin is also associated with more favorable effects on glycemic variability—a risk factor for hypoglycemia—than combining metformin, basal insulin, and prandial insulin ( 41. Diabetes Care. 2016; 39: 973-981 Crossref PubMed Scopus (67) Google Scholar ). •In long-duration T2DM ( 15. Garber A.J. Abrahamson M.J. Barzilay J.I. et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2016 executive summary. Endocr Pract. 2016; 22: 84-113 Abstract Full Text Full Text PDF PubMed Google Scholar , 42. Lebovitz H.E. Insulin secretagogues: old and new. Diabetes Rev. 1999; 7: 139-153 Google Scholar ). The loss of β-cell function is inevitable as T2DM progresses: if patients live long enough, they will eventually require insulin therapy ( 43. Turner R.C. Cull C.A. Frighi V. Holman R.R. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). JAMA. 1999; 281: 2005-2012 Crossref PubMed Scopus (1983) Google Scholar , 44. Reach G. Le Pautremat V. Gupta S. Determinants and consequences of insulin initiation for type 2 diabetes in France: analysis of the National Health and Wellness Survey. Patient Prefer Adherence. 2013; 7: 1007-1023 Crossref PubMed Scopus (23) Google Scholar ).