L’insulina alla luce delle nuove linee guida italiane per il trattamento del diabete di tipo 2: quando, in chi e perché?

Aim: this editorial is aimed at providing a reference for the insulin treatment of type 2 diabetes in adults. Methods and results: the present paper revised the recently published Italian guidelines for the treatment of type 2 diabetes (outpatients), either in primary care or specialist referral. The guideline has been developed following the methods described in the Manual of the National Guideline System (http://www.snlg-iss.it) by a panel nominated by the Società Italiana di Diabetologia (SID) and Associazione Medici Diabetologi (AMD). Prior cardiovascular events, heart failure, hypoglycemic risk, and other conditions have been considered as factors capable of modifying treatment strategies. The following areas have been assessed: 1) position of the insulin therapy in the new algorithms; 2) type of formulations (insulin analogues or human insulin); 3) use of insulin infusion pumps. Conclusions: insulin should be used only as a second/thirdline therapy due to its lower efficacy on long-term HbA1c, higher risk of hypoglycemia, and neutral effects on cardiorenal outcomes. Human insulin formulations should be avoided for safety concerns (higher hypoglycemic risk) with no preference among different insulin analogues. Insulin pumps are not recommended for the treatment of type 2 diabetes.