Insulin based combination treatments of patients with obesity and type 2 diabetes

Besides classical antidiabetic goals the contemporary diabetology more intensely focuses on the reduction of cardiovascular risk factors of type 2 diabetic patients. Especially, potentially deleterious consequences of insulin therapies are debated, since avoiding hypoglycemic events and the possibility of weight loss represent advantageous cardiovascular effects of an antidiabetic therapy. On the other hand, a large proportion of patients receive insulin treatment during progression of the disease. In order to improve the cardiovascular risk profile of these patients, the combination of insulin with additional oral antidiabetic treatment should be considered. Positive effects are yielded, if the combination allows an optimized glucose control without an increase of hypoglycemic events or weight gain, or if the insulin dose and the body weight can be reduced. Options of such insulin based combination treatments and their potential cardiovascular impact are discussed.