Optimising Insulin Therapy in Modern Type 2 Diabetes Care: A Narrative Review

Abstract

Background: Type 2 diabetes mellitus is a chronic metabolic condition affecting millions of adults worldwide. Despite newer treatment modalities such as GLP-1 receptor agonists, SGLT2 inhibitors, and tirzepatide, insulin remains vital for many patients. This is particularly the case for those with advanced beta-cell dysfunction, severe hyperglycaemia, or inadequate glycaemic control despite non-insulin therapies. Objective: This narrative review outlines the changing landscape of insulin therapy for type 2 diabetes, and focuses on personalisation of treatment, combination therapy, minimising adverse events, digital technologies and safe de-intensification. Methods: Literature was reviewed from PubMed, Scopus, and Google Scholar, focusing mainly on clinical trials, systematic reviews, meta-analyses, major guidelines, and relevant expert reviews published between 2016 and 2026. Landmark older studies were included where clinically relevant. Key Findings: The use of insulin is still strongly influencing glycaemic control but is now more guided by new therapies and technologies. GLP-1 receptor agonists, SGLT2 inhibitors, and tirzepatide can be combined to lower the amount of insulin needed for treatment, help prevent weight gain, improve cardiometabolic outcomes, and decrease treatment burden in certain patients. New technologies such as smart insulin pens and digital titration devices facilitate more accurate insulin dosing and decrease the risk of hypoglycaemia. Patient-led titration and safe de-intensification are also important particularly for high-risk individuals for hypoglycaemia. Conclusion: Insulin therapy remains indispensable in type 2 diabetes care, but its optimal use now requires a more digitally supported, and patient-centred approach. The key concern is no longer whether insulin remains necessary, but how its use can be optimised to improve effectiveness and fit safely within modern type 2 diabetes care.