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Metformin has been proven beneficial for the first-line treatment of type 2 diabetic mellitus (T2DM) due to its efficacy and low adverse effect profile. Current US guidelines do not address the use of early intensive insulin use in T2DM. Treatment plans are slowly adjusted over the months until the A1C goal is met. Insulin is initiated several years after the time of T2DM diagnosis and utilized as second-line therapy. Dual therapy of insulin and metformin have shown regression of T2DM in certain patient populations. However, the linear relationship between diabetes and cardiovascular disease does not show greater improvement with dual aggressive therapy. The ACCORD study found intensive insulin use has led to an increase in mortality in diabetic patients. The purpose of this literature review is to gather data using clinical studies and peer-reviewed articles that can determine if metformin and insulin should be used intensively to lower A1C aggressively compared to using standard therapy of metformin to decrease the long-term effects of abnormal A1C levels.


Physician Assistant Studies

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Master of Physician Assistant Studies (MPAS)

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insulin; metformin; dual therapy; regression; mortality; A1C; intensive insulin therapy; guidelines


Cardiovascular Diseases | Endocrinology, Diabetes, and Metabolism | Nutritional and Metabolic Diseases

Early Aggressive Insulin Therapy in Type 2 Diabetes