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This editorial was published in the International Journal of Clinical Practice Volume 62, Issue 6, November 2008, Pages 845-847. The published version is available at . DOI: 10.1111/j.1742-1241.2008.01757.x. Copyright © Wiley InterScience..


Primary care physicians (PCPs) provide diabetes care for 82% of patients with type 2 diabetes (1). Many patients with type 2 diabetes will eventually need insulin. The UKPDS (2) showed that ß-cell failure is progressive. From 50% of normal ß-cell function present at diagnosis, there is a steady decline with almost complete loss of ß-cell mass within 10-15 years, even earlier in some patients. On average, as many as 40-80% of patients with type 2 diabetes will need insulin within 10 years after diagnosis (1,2). These statistics can vary between patients and depending on the different agents used after the initial diagnosis. UKPDS did not include thiazolidinediones or GLP-1 based therapies, which could potentially have a completely different effect on the ß-cells and perhaps delay the need for insulin.

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