<p>If T2 diabetics “frequently” progress to insulin injection, it is mostly likely because they do not control their BG through appropriate diet, thus burning out their remaining insulin-producing cells. Oral medications that push the pancreas to produce yet more insulin are likely only to exacerbate this situation, unlike metformin, which is not only the most effective drug out there according to many studies, but very cheap. (Unlike the newer drugs, which also expose T2s to the possibility of dangerous lows.) I really object to simply accepting this progression as inevitable, and would caution against making statements that make it seem inevitable. It is bad enough that the ADA publishes tripe that suggests that an HBA1C of about 7 is “close control” and risky to maintain. If you want to see why they study what they study and recommend what they recommend, just look at their corporate sponsors.</p>
<p>I happen to know a number of older T2 diabetics: one around 70 and the others their 80s. None of them are on insulin. The youngest is the only one with complications, and she is also the only one who consistently fails to control her diet.</p>