Insulin as a first-line therapy in type 2 diabetes: should the use of sulfonylureas be halted?

B ecause a tidal wave of type 2 diabetes is presently rolling on a global scale, owing to the ever-increasing prevalence of obesity along with overnutrition, increasing physical inactivity, and aging populations worldwide, the debate is still ongoing over the appropriate firstline therapy. Recently, the International Diabetes Federation and the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) suggested distinct treatment algorithms (Fig. 1) (1), which have sparked the discussion even further, although there is strong agreement that weightregulating nutrition and a prudent lifestyle are the cornerstones of any treatment. Here, the pro and con discussion explores the use of insulin versus sulfonylureas as first-line pharmacotherapy.