When one considers initiation of insulin therapy in a type 2 diabetic patient with the intention to preserve β-cell function, the level of evidence supporting this decision is relatively high.
For the subgroup of patients with severe symptomatic hyperglycemia, there is strong evidence, in addition to guideline recommendations (American Diabetes Association/ European Association for the Study of Diabetes, International Diabetes Federation, American Association of Clinical Endocrinologists, Canadian, and National Institute for Health and Care Excellence [
12–
16]), to support initiation of short-term insulin therapy. Insulin therapy is an effective way to reverse short-term glucotoxicity and lipotoxicity and shows evidence of midterm β-cell preservation. Short-term insulin treatment is safe, with low incidence of hypoglycemia (
23–
25) and less concern for weight gain. However, the best method for insulin treatment in such cases—basal insulin, premix insulin analogs, MDII, or CSII—and the length of insulin therapy should be further studied.