This interesting randomized trial tested three forms of insulin therapy in the management of poorly controlled type 2 diabetic patients receiving maximally tolerated doses of metformin and sulfonylurea. In this one-year interim analysis of treating to target in type 2 diabetes (4-T) study, Holman et al. reported a substantial body weight gain among patients receiving either biphasic insulin twice daily or prandial insulin immediately before meals. Patients who received basal insulin at bedtime gained less weight, but this smaller weight gain was associated with a less substantial reduction in hemoglobin A1c levels. The authors concluded from the interim analysis of the 4-T study that most type 2 diabetic patients requiring insulin therapy are likely to need more than one type of insulin to achieve target glucose levels. Furthermore, the substantial weight gain of ~ 5 kg observed after one year in patients under intensive insulin therapy emphasizes the notion that these type 2 diabetic patients desperately need proper support in the form of a lifestyle modification program to help them either lose weight or at least minimize the weight gain associated with intensive insulin therapy.
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