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Martin J. Abrahamson, MB, CHB, Discussant

JAMA. 2007;297:196-204.

Ms M, a 74-year-old woman with type 2 diabetes of 6 years' duration, has a glycated hemoglobin (HbA_1C) value of 7.4% despite taking 3 oral antidiabetic medications, as well as coexistent hypertension and abdominal obesity. She has no known microvascular or macrovascular complications of diabetes and is otherwise healthy. She is reluctant to commence insulin treatment as she dislikes the idea of injections and wonders if there are any alternate options if she is to get her HbA_1C value below 7%. The natural history of type 2 diabetes, reasons why many patients begin requiring insulin over time, rationale for tight glycemic control, and therapeutic options for Ms M are discussed.

Author Affiliation: Dr Abrahamson is Associate Professor of Medicine at Harvard Medical School and Medical Director, Joslin Diabetes Center, Boston, Mass.

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